Kenneth J Victor, PSY. D.

Primary specialty

PsychologistTaxonomy code 103T00000X

License

20041162A Issued in IN

Practice address

6541 Specker Ave BLDG 1830
Fort Carson, CO 80913-4263

Phone

(791) 526-7155

NPI assigned

Jan 4, 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 identifiers 3

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Philosophy

State licenses

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.

• Union Hospital, Inc.

  • Medicare Defined Swing Bed Hospital Unit
  • Clinton, IN
  • NPI 1487652319
  NPD (past)

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

{
    "created_epoch": "1136332800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1701129600000",
    "number": "1720066376",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6541 SPECKER AVE BLDG 1830",
            "city": "FORT CARSON",
            "state": "CO",
            "postal_code": "809134263",
            "telephone_number": "719-526-7155"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6541 SPECKER AVE BLDG 1830",
            "city": "FORT CARSON",
            "state": "CO",
            "postal_code": "809134263",
            "telephone_number": "791-526-7155"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VICTOR",
        "first_name": "KENNETH",
        "middle_name": "J",
        "credential": "PSY. D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-01-04",
        "last_updated": "2023-11-28",
        "certification_date": "2023-11-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "IN",
            "license": "20041162A",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "200165440",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR",
            "identifier": "P00196681",
            "state": "IN"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "P00453703",
            "state": "IL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Alesia Marcella Vega, RN
• Stefano Vendraminetto
• Robert Ventura, P.A-C
• Elfriede E Vernon, PA
• Ryan Vetor, M.D.
• Nick Vigil, PA-C
• Gabriel Andres Villalba, DMD
• Leslie Ann Villalobos
• Ryan Zareno Villanueva
• Jaime Viramontes Jr., DMD

• Psychologist in Fort Carson, CO
• Providers in Fort Carson, CO by specialty
• Psychologist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 28, 2023; 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.