Active NPI
Kevin L Gyoerkoe, PSY.D.
- Clinical Psychologist
- Charlotte, NC
National Provider Identifier
1629324975
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Clinical Psychologist
- License
- 4092
- Practice address
- 8832 Blakeney Professional Dr
Suite 105
Charlotte, NC 28277-6809 - Phone
- (704) 631-3980
- NPI assigned
- Jul 24, 2012
- 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 |
|---|---|---|---|---|
| Clinical Psychologist | 103TC0700X | 4092 | NC | Primary |
Addresses
Primary practice location
8832 Blakeney Professional Dr
Suite 105
Charlotte, NC 28277-6809
Mailing address
8832 Blakeney Professional Dr
Suite 105
Charlotte, NC 28277-6809
Phone (704) 631-3980
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Opted out of Medicare
- Yes, effective Jan 23, 2023 through Jan 23, 2027
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4092 | NC | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1343088000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1343088000000",
"number": "1629324975",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "8832 BLAKENEY PROFESSIONAL DR",
"address_2": "SUITE 105",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282776809",
"telephone_number": "704-631-3980"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "8832 BLAKENEY PROFESSIONAL DR",
"address_2": "SUITE 105",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282776809",
"telephone_number": "704-631-3980"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GYOERKOE",
"first_name": "KEVIN",
"middle_name": "L",
"name_prefix": "Dr.",
"credential": "PSY.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2012-07-24",
"last_updated": "2012-07-24",
"status": "A"
},
"taxonomies": [
{
"code": "103TC0700X",
"taxonomy_group": "",
"desc": "Psychologist, Clinical",
"state": "NC",
"license": "4092",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.