Active NPI
Kelly Charles Evans, PH.D.
- Counseling Psychologist
- Wausau, WI
National Provider Identifier
1720165251
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Counseling Psychologist
- License
- 2027
- Practice address
- 2714 Stewart Ave
Wausau, WI 54401-4153 - Phone
- (715) 849-3988
- Fax
- (715) 849-3988
- NPI assigned
- Nov 1, 2006
- 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 |
|---|---|---|---|---|
| Counseling Psychologist | 103TC1900X | 2027 | WI | Primary |
Addresses
Primary practice location
2714 Stewart Ave
Wausau, WI 54401-4153
Mailing address
2714 Stewart Ave
Wausau, WI 54401-4153
Phone (715) 849-3988
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 39120800 | Medicaid | WI |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
Enrollment records 1
Care Compare profile
Medicare Care Compare- Specialty
- Clinical Psychologist
- Education
- University of Missouri, Kansas City, School of Medicine, 1994
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
Practice addresses (Care Compare)
2714 Stewart Ave
Wausau, WI 54401-4153
Phone (715) 849-3988
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2027 | WI | MD | Nurse Practitioner |
Organizations & group practices 1
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.
-
- Community/Behavioral Health Agency
- Wausau, WI
- NPI 1215146907
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1162339200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1720165251",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2714 STEWART AVE",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544014153",
"telephone_number": "715-849-3988",
"fax_number": "715-849-3988"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2714 STEWART AVE",
"city": "WAUSAU",
"state": "WI",
"postal_code": "544014153",
"telephone_number": "715-849-3988",
"fax_number": "715-849-3988"
}
],
"practiceLocations": [],
"basic": {
"last_name": "EVANS",
"first_name": "KELLY",
"middle_name": "CHARLES",
"name_prefix": "Dr.",
"credential": "PH.D.",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-11-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "103TC1900X",
"taxonomy_group": "",
"desc": "Psychologist, Counseling",
"state": "WI",
"license": "2027",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "39120800",
"state": "WI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wausau, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.
- Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.