Active NPI
Kaci Wilson, PSYD
- Clinical Neuropsychologist
- Winter Park, FL
National Provider Identifier
1336025790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Neuropsychologist
- Practice address
- 1573 W Fairbanks Ave Ste 220
Winter Park, FL 32789-4679 - Phone
- (407) 303-7991
- NPI assigned
- Aug 12, 2025
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Clinical Neuropsychologist | 103G00000X | Primary |
Addresses
Primary practice location
1573 W Fairbanks Ave Ste 220
Winter Park, FL 32789-4679
Mailing address
4170 Sage Brush Cir
Melbourne, FL 32901-8225
Phone (715) 495-0064
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1754956800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1754956800000",
"number": "1336025790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4170 SAGE BRUSH CIR",
"city": "MELBOURNE",
"state": "FL",
"postal_code": "329018225",
"telephone_number": "715-495-0064"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1573 W FAIRBANKS AVE STE 220",
"city": "WINTER PARK",
"state": "FL",
"postal_code": "327894679",
"telephone_number": "407-303-7991"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KACI",
"credential": "PSYD",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-08-12",
"last_updated": "2025-08-12",
"certification_date": "2025-08-12",
"status": "A"
},
"taxonomies": [
{
"code": "103G00000X",
"taxonomy_group": "",
"desc": "Clinical Neuropsychologist",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Winter Park, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.