Kimberly Shannon Wilson, PHD

Primary specialty

PsychologistTaxonomy code 103T00000X

License

P0000002498 Issued in TN

Practice address

5401 Kingston Pike
Ste 170
Knoxville, TN 37919-5022

Phone

(865) 584-4005

Fax

(865) 584-5551

NPI assigned

Jan 22, 2007

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: No
• Power mobility devices: No
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Clinical Psychologist

Education

University of Tennessee, HSC, College of Medicine, 2001

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Bearden Psychological & Wellness Center, PLLC

  • Clinical Psychologist
  • Knoxville, TN
  • NPI 1942568019
  NPD (past)
• Bearden Psychological and Wellness Center

  • Mental Health Clinic/Center (Including Community Mental Health Center)
  • Knoxville, TN
  • NPI 1972905156
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1169424000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1439769600000",
    "number": "1316091119",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "813 S NORTHSHORE DR",
            "address_2": "STE 105",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379197594",
            "telephone_number": "865-584-4005",
            "fax_number": "865-584-5551"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 KINGSTON PIKE",
            "address_2": "STE 170",
            "city": "KNOXVILLE",
            "state": "TN",
            "postal_code": "379195022",
            "telephone_number": "865-584-4005",
            "fax_number": "865-584-5551"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KIMBERLY",
        "middle_name": "SHANNON",
        "credential": "PHD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-01-22",
        "last_updated": "2015-08-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TN",
            "license": "P0000002498",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "3983201",
            "state": "TN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Jennifer Danielle Wilson, B.S.
• Jennifer Jackson Wilson, M.A. CCC-SLP
• Jennifer R Wilson, R.N.
• John Wilson III, CPRS
• Julia E Wilson, LMFT
• Kristina Wilson
• Landon Wilson, DMD
• Lauren Wilson
• Madden Wilson, RDN, LDN, CNSC
• Mary M. Wilson, M.A., CCC-SLP

• Psychologist in Knoxville, TN
• Providers in Knoxville, TN by specialty
• Psychologist in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.