Active NPI
Kelley Wilson, PH.D.
- Psychologist
- Summerdale, AL
National Provider Identifier
1346605714
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 1992
- Practice address
- 310 State Highway 59 N
Summerdale, AL 36580-3620 - Phone
- (251) 979-5066
- NPI assigned
- Dec 29, 2015
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 1992 | AL | Primary |
Addresses
Primary practice location
310 State Highway 59 N
Summerdale, AL 36580-3620
Mailing address
5750A Southland Dr
Mobile, AL 36693-3316
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)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1992 | AL | MD | Sports Medicine (Emergency Medicine) Physician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kelley Wilson Psychological Services, LLC | Psychologist | Current | Accepting new patients |
Organizations & group practices 1
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.
-
- Psychologist
- Daphne, AL
- NPI 1336989912
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1451347200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1715558400000",
"number": "1346605714",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5750A SOUTHLAND DR",
"city": "MOBILE",
"state": "AL",
"postal_code": "366933316"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "310 STATE HIGHWAY 59 N",
"city": "SUMMERDALE",
"state": "AL",
"postal_code": "365803620",
"telephone_number": "251-979-5066"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KELLEY",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2015-12-29",
"last_updated": "2024-05-13",
"certification_date": "2024-05-13",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "AL",
"license": "1992",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Summerdale, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 13, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.