Andrea Denise Wickersham, PSY.D.

Primary specialty

Clinical PsychologistTaxonomy code 103TC0700X

License

129186 Issued in KY

Practice address

117 Old Soldiers LN
Frankfort, KY 40601-6159

Phone

(502) 875-7272

NPI assigned

Mar 26, 2018

Sex

Female

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

Enrolled in KY

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

Practice roles

Locations

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.

• PPL Therapeutic Services PLLC

  • Professional Counselor
  • Crestwood, KY
  • NPI 1104323252

  Clinical

  Medicare reassignment NPD

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

{
    "created_epoch": "1522022400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1525737600000",
    "number": "1942705652",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1016 PARK PLACE DR",
            "city": "RICHMOND",
            "state": "KY",
            "postal_code": "404753442",
            "telephone_number": "859-582-7433"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "117 OLD SOLDIERS LN",
            "city": "FRANKFORT",
            "state": "KY",
            "postal_code": "406016159",
            "telephone_number": "502-875-7272"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "WICKERSHAM",
        "first_name": "ANDREA",
        "middle_name": "DENISE",
        "name_prefix": "Dr.",
        "credential": "PSY.D.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-03-26",
        "last_updated": "2018-05-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "KY",
            "license": "129186",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "7100519190",
            "state": "KY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Westside Family Chiropractic and Rehabilitation PSC
• Phoebe Ann Wheelercrum
• Whispering Winds Community Living, Inc.
• Connie Gayle White, MD
• Teresa M. White, PT
• Michael Widjaja, MD
• Craig Burdette Wiggins, DMD
• Claire Ryan Wigglesworth, LAC
• Sandra Kaye Wilcox, M.S, CCC
• Samantha L Wilcoxson

• Clinical Psychologist in Frankfort, KY
• Providers in Frankfort, KY by specialty
• Clinical Psychologist in Kentucky

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 8, 2018; 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.