Kenneth W Wilson, M.D.

Primary specialty

Psychiatry PhysicianTaxonomy code 2084P0800X

License

194765 Issued in NY

Practice address

45 Reade PL
Joseph Tower, 1St Floor
Poughkeepsie, NY 12601-3947

Phone

(845) 483-6654

NPI assigned

Dec 18, 2006

Last updated

Sep 24, 2012By the provider in NPPES

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 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Opted out of Medicare

Yes, effective Dec 18, 2014 through Dec 18, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Nuvance Health Medical Practice PC

  • Internal Medicine Physician
  • Poughkeepsie, NY
  • NPI 1437358033

  Psychiatry

  NPD (past)
• Riverview Psychiatric Medicine PC

  • Adult Mental Health Clinic/Center
  • Poughkeepsie, NY
  • NPI 1174789812
  NPD (past)
• Riverview Psychiatric Medicine, PC

  • Psychiatry Physician
  • Poughkeepsie, NY
  • NPI 1881005460
  NPD (past)

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

{
    "created_epoch": "1166400000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1348444800000",
    "number": "1780747220",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1351 ROUTE 55 STE 200",
            "city": "LAGRANGEVILLE",
            "state": "NY",
            "postal_code": "125405128",
            "telephone_number": "845-483-6654"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "45 READE PL",
            "address_2": "JOSEPH TOWER, 1ST FLOOR",
            "city": "POUGHKEEPSIE",
            "state": "NY",
            "postal_code": "126013947",
            "telephone_number": "845-483-6654"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILSON",
        "first_name": "KENNETH",
        "middle_name": "W",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-12-18",
        "last_updated": "2012-09-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "2084P0800X",
            "taxonomy_group": "",
            "desc": "Psychiatry & Neurology, Psychiatry",
            "state": "NY",
            "license": "194765",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "LICENSE #",
            "identifier": "194765",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Zakiyah Kiara Williams, IBCLC
• Karen Williamson, LPN
• James Joseph Willoughby, D.D.S.
• Amy C Wilson, CMHC
• Christine Wilson, AGACNP
• Paul Thomas Wilson, P.A.
• Shaniqua Nicole Wilson
• Hla-Pe Win, M.D.
• Chelsea Winant
• Lauren Alexandra Winfrey

• Psychiatry Physician in Poughkeepsie, NY
• Providers in Poughkeepsie, NY by specialty
• Psychiatry Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2012; 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.