Active NPI
Kenton Lee Wertman, PH.D.
- Psychologist
- Clayton, MO
National Provider Identifier
1609942721
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychologist
- License
- 01403
- Practice address
- 130 S Bemiston Ave
Ste. 506
Clayton, MO 63105-1913 - Phone
- (314) 863-6161
- Fax
- (314) 863-6695
- NPI assigned
- Nov 28, 2006
- 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 |
|---|---|---|---|---|
| Psychologist | 103T00000X | 01403 | MO | Primary |
Addresses
Primary practice location
130 S Bemiston Ave
Ste. 506
Clayton, MO 63105-1913
Mailing address
130 S Bemiston Ave
Ste. 506
Clayton, MO 63105-1913
Phone (314) 863-6161
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 000070720 | Other | MO | PTAN |
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 |
|---|---|---|---|
| 01403 | MO | MD | Audiologist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1164672000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1358294400000",
"number": "1609942721",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "130 S BEMISTON AVE",
"address_2": "STE. 506",
"city": "CLAYTON",
"state": "MO",
"postal_code": "631051913",
"telephone_number": "314-863-6161",
"fax_number": "314-863-6695"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "130 S BEMISTON AVE",
"address_2": "STE. 506",
"city": "CLAYTON",
"state": "MO",
"postal_code": "631051913",
"telephone_number": "314-863-6161",
"fax_number": "314-863-6695"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WERTMAN",
"first_name": "KENTON",
"middle_name": "LEE",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-28",
"last_updated": "2013-01-16",
"status": "A"
},
"taxonomies": [
{
"code": "103T00000X",
"taxonomy_group": "",
"desc": "Psychologist",
"state": "MO",
"license": "01403",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "PTAN",
"identifier": "000070720",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Clayton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.