Active NPI
David Ray Wilkins II, PHD
- Clinical Psychologist
- Olive Branch, MS
National Provider Identifier
1609508951
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- P0000001854
- Practice address
- 6724 Persimmon CV
Olive Branch, MS 38654-4331 - Phone
- (901) 603-1111
- NPI assigned
- Jun 27, 2022
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | P0000001854 | TN | Primary |
Addresses
Primary practice location
6724 Persimmon CV
Olive Branch, MS 38654-4331
Mailing address
6724 Persimmon CV
Olive Branch, MS 38654-4331
Phone (901) 603-1111
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 |
|---|---|---|---|
| P0000001854 | TN | MD | Clinical Psychologist |
| 1854 | TN | MD | Speech-Language Pathologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1656288000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1656288000000",
"number": "1609508951",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6724 PERSIMMON CV",
"city": "OLIVE BRANCH",
"state": "MS",
"postal_code": "386544331",
"telephone_number": "901-603-1111"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6724 PERSIMMON CV",
"city": "OLIVE BRANCH",
"state": "MS",
"postal_code": "386544331",
"telephone_number": "901-603-1111"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILKINS",
"first_name": "DAVID",
"middle_name": "RAY",
"name_prefix": "Dr.",
"name_suffix": "II",
"credential": "PHD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2022-06-27",
"last_updated": "2022-06-27",
"certification_date": "2022-06-27",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "TN",
"license": "P0000001854",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Olive Branch, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 27, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.