Active NPI
Keldon Oliver Wilson
- Rehabilitation Psychologist
- Kalamazoo, MI
National Provider Identifier
1407511280
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Rehabilitation Psychologist
- Practice address
- 2236 Brook Dr
Kalamazoo, MI 49048-2806 - Phone
- (269) 492-7205
- NPI assigned
- Nov 5, 2021
- Sex
- Male
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Rehabilitation Psychologist | 103TR0400X | Primary |
Addresses
Primary practice location
2236 Brook Dr
Kalamazoo, MI 49048-2806
Mailing address
1800 Ring Rd S Apt 6321
Kalamazoo, MI 49008-1002
Phone (517) 213-3527
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | Hopenetwork |
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": "1636070400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1636070400000",
"number": "1407511280",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1800 RING RD S APT 6321",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490081002",
"telephone_number": "517-213-3527"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2236 BROOK DR",
"city": "KALAMAZOO",
"state": "MI",
"postal_code": "490482806",
"telephone_number": "269-492-7205"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KELDON",
"middle_name": "OLIVER",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2021-11-05",
"last_updated": "2021-11-05",
"certification_date": "2021-11-05",
"status": "A"
},
"taxonomies": [
{
"code": "103TR0400X",
"taxonomy_group": "",
"desc": "Psychologist, Rehabilitation",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "Hopenetwork",
"affiliation": "N",
"address_1": "2236 Brook Dr",
"city": "Kalamazoo",
"state": "MI",
"country_code": "US",
"postal_code": "490482806",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Kalamazoo, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.