Keith A Wilson, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

004702 Issued in TN

Practice address

650 Joel Dr
Fort Campbell, KY 42223-5318

Phone

(270) 798-8601

Fax

(270) 798-8239

NPI assigned

Feb 22, 2006

Sex

Male

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

• Keith Foster-Wilson Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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.

• TML Behavioral Health Group LLC

  dba TML Villa Canyon

  • Psychiatric Residential Treatment Facility
  • Castaic, CA
  • NPI 1003661737
  NPD
• Caroline B Williams PHD PC

  • Prescribing (Medical) Psychologist
  • Boerne, TX
  • NPI 1356316814
  NPD (past)
• Octave Behavioral Health PC

  • Psychologist
  • San Francisco, CA
  • NPI 1184199549
  NPD (past)

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

{
    "created_epoch": "1140566400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1629043609",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 40406",
            "city": "NASHVILLE",
            "state": "TN",
            "postal_code": "372040406",
            "telephone_number": "615-463-6608",
            "fax_number": "615-463-6603"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "650 JOEL DR",
            "city": "FORT CAMPBELL",
            "state": "KY",
            "postal_code": "422235318",
            "telephone_number": "270-798-8601",
            "fax_number": "270-798-8239"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KEITH",
        "middle_name": "A",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-02-22",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "TN",
            "license": "004702",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KEITH",
            "last_name": "FOSTER-WILSON",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Heather Nicole Willis, PSY.D.
• Michele Lynn Willis, CPHT
• Aaron Wilson
• Christopher Ray Wilson, PH.D.
• Damariun Wilson
• Valerie Letrice Wilson, DPT
• Samantha Lynne Winder, ATC
• Hans Martin Winebrenner
• Gerald Winger
• Nichole Winn, LPN

• Clinical Social Worker in Fort Campbell, KY
• Providers in Fort Campbell, KY by specialty
• Clinical Social Worker in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.