Individual provider Active NPI

Kristin M. Phillips, PHD

  • Clinical Psychologist
  • Tampa, FL
National Provider Identifier
1417210329
Registry record updated Aug 21, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
PY8479 Issued in FL
Practice address
13000 Bruce B Downs Blvd
116B
Tampa, FL 33612-4745
Phone
(813) 972-2000
NPI assigned
Jun 18, 2012
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 21, 2012

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X PY8479 FL Primary

Addresses

Primary practice location

13000 Bruce B Downs Blvd
116B
Tampa, FL 33612-4745

Mailing address

13000 Bruce B Downs Blvd
116B
Tampa, FL 33612-4745
Phone (813) 972-2000

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in FL
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

Enrollment IDStateProvider typePAC IDDetails
I20220504002094 FL Practitioner - Clinical Psychologist 0749446029 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 2009
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Wellness Psychological Services, PLLCGroup PAC ID 4587969977, 15 clinicians

Practice addresses (Care Compare)

205 S Hoover Blvd
Suite 202
Tampa, FL 33609-3574
Phone (813) 563-1155

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

Practice roles

OrganizationSpecialtyStatusNew patients
Wellness Psychological Services PLLC CurrentSince Apr 5, 2023 Accepting new patients

Locations

205 S Hoover Blvd
Ste 202
Tampa, FL 33609
Phone (813) 563-1155

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.

NPI Registry JSON

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

{
    "created_epoch": "1339977600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1345507200000",
    "number": "1417210329",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13000 BRUCE B DOWNS BLVD",
            "address_2": "116B",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336124745",
            "telephone_number": "813-972-2000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13000 BRUCE B DOWNS BLVD",
            "address_2": "116B",
            "city": "TAMPA",
            "state": "FL",
            "postal_code": "336124745",
            "telephone_number": "813-972-2000"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "KRISTIN",
        "middle_name": "M.",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2012-06-18",
        "last_updated": "2012-08-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "FL",
            "license": "PY8479",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Tampa, FL

Sources for this page

Verify at the official NPI Registry.