Active NPI
Katherine D Wyatt, LCMHC
- Mental Health Counselor
- Kernersville, NC
National Provider Identifier
1467413393
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- 4900
- Practice address
- 110 Kelvdon Dr
Kernersville, NC 27284-8387 - Phone
- (252) 474-4645
- NPI assigned
- Mar 30, 2006
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | 4900 | NC | Primary |
Addresses
Primary practice location
110 Kelvdon Dr
Kernersville, NC 27284-8387
Mailing address
110 Kelvdon Dr
Kernersville, NC 27284-8387
Phone (252) 474-4645
Other identifiers 6
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 194339 | Other | NC | MEDCOST |
| 831160000 | Other | NC | MAGELLAN |
| 204836896 | Other | NC | TRICARE |
| 2268491 | Other | NC | CIGNA |
| 1400F | Other | NC | BC |
| 6102822 | Medicaid | NC |
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4900 | NC | MD | Psychologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1143676800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1620172800000",
"number": "1467413393",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 KELVDON DR",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272848387",
"telephone_number": "252-474-4645"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "110 KELVDON DR",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272848387",
"telephone_number": "252-474-4645"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYATT",
"first_name": "KATHERINE",
"middle_name": "D",
"name_prefix": "Mrs.",
"credential": "LCMHC",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2006-03-30",
"last_updated": "2021-05-05",
"certification_date": "2021-05-05",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": "NC",
"license": "4900",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MEDCOST",
"identifier": "194339",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MAGELLAN",
"identifier": "831160000",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "TRICARE",
"identifier": "204836896",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "CIGNA",
"identifier": "2268491",
"state": "NC"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BC",
"identifier": "1400F",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "6102822",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kernersville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 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.