Individual provider Active NPI

Kenneth Wilgus, PH.D.

  • Psychologist
  • McKinney, TX
National Provider Identifier
1831590785
Registry record updated Sep 10, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
24699 Issued in TX
Practice address
206 S Kentucky St
Suite 100
McKinney, TX 75069-5439
Phone
(972) 696-9456
NPI assigned
Sep 10, 2014
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 10, 2014

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Psychologist 103T00000X 24699 TX Primary

Addresses

Primary practice location

206 S Kentucky St
Suite 100
McKinney, TX 75069-5439

Mailing address

206 S Kentucky St
Suite 100
McKinney, TX 75069-5439
Phone (972) 696-9456

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)
Not enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
24699TXMDGeneral Practice Dentistry

NPI Registry JSON

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

{
    "created_epoch": "1410307200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1410307200000",
    "number": "1831590785",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "206 S KENTUCKY ST",
            "address_2": "SUITE 100",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750695439",
            "telephone_number": "972-696-9456"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "206 S KENTUCKY ST",
            "address_2": "SUITE 100",
            "city": "MCKINNEY",
            "state": "TX",
            "postal_code": "750695439",
            "telephone_number": "972-696-9456"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WILGUS",
        "first_name": "KENNETH",
        "name_prefix": "Dr.",
        "credential": "PH.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2014-09-10",
        "last_updated": "2014-09-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "",
            "desc": "Psychologist",
            "state": "TX",
            "license": "24699",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in McKinney, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 10, 2014; 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.