Kelly Wild, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

35793 Issued in CA

Practice address

1011 22ND St
Sacramento, CA 95816-4907

Phone

(916) 284-1416

NPI assigned

Jun 18, 2019

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Ms. Kelly Gill Former name

Medicare fee-for-service enrollment

Enrolled in CA

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

Specialty

Clinical Psychologist

Education

Other, 2022

Medicare assignment

May accept Medicare assignment

Group practices

Vantage Point Center for PsychotherapyGroup PAC ID 0749518140, 13 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

State licenses

Practice roles

Locations

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.

• Vantage Point Center for Psychotherapy

  • Mental Health Counselor
  • Sacramento, CA
  • NPI 1326417056
  Medicare reassignment Care Compare group NPD
• Dr. Trisha D Wallis, Psychologist, Apc

  • Clinical Psychologist
  • Sacramento, CA
  • NPI 1346862620
  NPD

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

{
    "created_epoch": "1560816000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743120000000",
    "number": "1609436906",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2131 CAPITOL AVE STE 206",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958165755",
            "telephone_number": "916-284-1416"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 22ND ST",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958164907",
            "telephone_number": "916-284-1416"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILD",
        "first_name": "KELLY",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-06-18",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "CA",
            "license": "35793",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "GILL",
            "prefix": "MS.",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Jean Edmondson Wilcox, PH.D., PSY.D.
• Katrina Wilcox
• Quentin Micah Wilcox
• Richard Lyman Wilcox, CP
• Alyssa Renee Wild
• Madison Wilde
• Brent W Wilder
• Pia Jane Wilder
• Sara Ann Wildermuth, M.PT
• Earnest Jeffery Wiles, PH.D.

• Clinical Psychologist in Sacramento, CA
• Providers in Sacramento, CA by specialty
• Clinical Psychologist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.