Individual provider Active NPI

Scott A. Wylie, PH.D.

  • Clinical Psychologist
  • Louisville, KY
National Provider Identifier
1700890571
Registry record updated Dec 7, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
173223 Issued in KY
Practice address
220 Abraham Flexner Way
Louisville, KY 40202
Phone
(502) 899-3626
Fax
(502) 899-7970
NPI assigned
Jul 28, 2006
Last updated
Dec 7, 2018By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2018

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

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Neuropsychologist 103G00000X 0810003670 VA
Clinical Psychologist 103TC0700X 0810003670 VA
Clinical Psychologist 103TC0700X PHD3062 TN
Clinical Psychologist 103TC0700X 173223 KY Primary

Addresses

Primary practice location

220 Abraham Flexner Way
Louisville, KY 40202

Mailing address

PO Box 909
Louisville, KY 40201-0909
Phone (502) 588-0325

Other practice location 1

3601 Tvc
Nashville, TN 37232-0001
Phone (615) 322-3000

Other practice location 2

3601 Tvc
Nashville, TN 37232-0001
Phone (615) 322-3000

Other identifiers 1

IdentifierTypeStateIssuer
0810003670OtherVAVA STATE LICENSE

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

LicenseStateTypeSpecialty
173223KYMDClinical Psychologist
PHD3062TNMDClinical Psychologist
0810003670VAMDClinical Psychologist
3062TNMDOptometrist

Practice roles

OrganizationSpecialtyStatusNew patients
Medical Group of Memphis LLC Past Accepting new patients
Chapman Senior Care, Inc. Clinical PastSince Apr 9, 2011 Accepting new patients

Organizations & group practices 2

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": "1154044800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1544140800000",
    "number": "1700890571",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 909",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402010909",
            "telephone_number": "502-588-0325",
            "fax_number": "502-588-0326"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "220 ABRAHAM FLEXNER WAY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "40202",
            "telephone_number": "502-899-3626",
            "fax_number": "502-899-7970"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3601 Tvc",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372320001",
            "country_code": "US",
            "telephone_number": "615-322-3000",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "3601 Tvc",
            "address_purpose": "LOCATION",
            "city": "Nashville",
            "state": "TN",
            "postal_code": "372320001",
            "country_code": "US",
            "telephone_number": "615-322-3000",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WYLIE",
        "first_name": "SCOTT",
        "middle_name": "A.",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-07-28",
        "last_updated": "2018-12-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103G00000X",
            "taxonomy_group": "",
            "desc": "Clinical Neuropsychologist",
            "state": "VA",
            "license": "0810003670",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "VA",
            "license": "0810003670",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TN",
            "license": "PHD3062",
            "primary": false
        },
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KY",
            "license": "173223",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "VA STATE LICENSE",
            "identifier": "0810003670",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.