Robert Wayne McKenzie, PH.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

25161 Issued in TX

Practice address

933 W Connally St
Tyler, TX 75701-1404

Phone

(903) 581-5714

Fax

(903) 534-1507

NPI assigned

Mar 28, 2007

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Other identifiers 2

Medicare fee-for-service enrollment

Enrolled in TX

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

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

Practice roles

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.

• Brittain & Associates Inc

  • Clinical Psychologist
  • Ore City, TX
  • NPI 1285650457
  Medicare reassignment
• East Texas Mental Health Associates

  • Clinical Social Worker
  • Tyler, TX
  • NPI 1649495235
  NPD (past)
• Joyce Foreman Shayler

  • Mental Health Counselor
  • Tyler, TX
  • NPI 1083707947
  NPD (past)

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

{
    "created_epoch": "1175040000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1212364800000",
    "number": "1700905957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "933 W CONNALLY ST",
            "address_2": "P.O. BOX 0297",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011404",
            "telephone_number": "903-752-1004",
            "fax_number": "903-683-3212"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "933 W CONNALLY ST",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757011404",
            "telephone_number": "903-581-5714",
            "fax_number": "903-534-1507"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCKENZIE",
        "first_name": "ROBERT",
        "middle_name": "WAYNE",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-03-28",
        "last_updated": "2008-06-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "TX",
            "license": "25161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100340204",
            "state": "TX"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RAIL ROAD MEDICARE",
            "identifier": "P00254134",
            "state": "TX"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• David Douglas McIntire, R.PH.
• David Clay McIntyre, AGNP-C
• Jennifer Marie McKelva, PA-C
• Michael McKelva
• Jennifer May McKenzie, RN
• Deborah McKinley- Waggoner
• James Wayne McKinley, M.D.
• Ivan McKinney, DDS
• John Ronald McKinney Jr., DO
• Melissa McKinney

• Clinical Psychologist in Tyler, TX
• Providers in Tyler, TX by specialty
• Clinical Psychologist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2008; 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.