Individual provider Active NPI

Jane Meredith Wootton, PH.D.

  • Psychologist
  • Louisa, VA
National Provider Identifier
1639393143
Registry record updated Dec 31, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
0810008088 Issued in VA
Practice address
209 W Main St
Ste 2
Louisa, VA 23093
Phone
(505) 225-8867
Fax
(505) 933-7530
NPI assigned
Apr 13, 2007
Last updated
Dec 31, 2024By the provider in NPPES
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Dec 31, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 1302 NM
Psychologist 103T00000X 0810008088 VA Primary

Addresses

Primary practice location

209 W Main St
Ste 2
Louisa, VA 23093

Mailing address

PO Box 739
Louisa, VA 23093-0739
Phone (505) 255-8867

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in VA
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

Enrollment IDStateProvider typePAC IDDetails
I20230213000936 VA Practitioner - Clinical Psychologist 3678745767 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Clinical Psychologist
Education
Other, 1998
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

209 W Main St
Suite 2
Louisa, VA 23093-9450
Phone (505) 225-8867

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
0810008088VAMDPsychologist
1302NMMDSpeech-Language Pathologist

Practice roles

OrganizationSpecialtyStatusNew patients
A Vibrant Mind Counseling, LLC CurrentSince Jun 21, 2022 Accepting new patients
Children's Hospital & Regional Medical Center 2 Past Accepting new patients

Locations

2900 Louisiana Blvd NE
Ste 200D
Albuquerque, NM 87110
Phone (505) 225-8867

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1176422400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1735603200000",
    "number": "1639393143",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 739",
            "city": "LOUISA",
            "state": "VA",
            "postal_code": "230930739",
            "telephone_number": "505-255-8867",
            "fax_number": "505-933-7530"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "209 W MAIN ST",
            "address_2": "STE 2",
            "city": "LOUISA",
            "state": "VA",
            "postal_code": "23093",
            "telephone_number": "505-225-8867",
            "fax_number": "505-933-7530"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WOOTTON",
        "first_name": "JANE",
        "middle_name": "MEREDITH",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2007-04-13",
        "last_updated": "2024-12-31",
        "certification_date": "2024-12-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "NM",
            "license": "1302",
            "primary": false
        },
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "VA",
            "license": "0810008088",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisa, VA

Sources for this page

Verify at the official NPI Registry.