DR. KELLY JENSEN WADE (NPI# 1396025698) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
Nation Provider ID (NPI) | 1396025698 |
Entity Type | Individual |
Full Name | DR. KELLY JENSEN WADE |
Credential | PSY.D. |
Practice Address |
130 Executive Center Pkwy Fredericksburg VA 22401-3100 |
Practice Telephone | 5403704468 |
Mailing Telephone | 5406994969 |
Enumeration Date | 2011-08-18 |
Last Update Date | 2019-09-13 |
Gender Code | F |
Is Sole Proprietor | N |
Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
---|---|---|---|---|---|
N | 103TC0700X |
Psychologist Specialization: Clinical |
0810006297 | VA | Behavioral Health & Social Service Providers |
Y | 103TC0700X |
Psychologist Specialization: Clinical |
0003934 | CO | Behavioral Health & Social Service Providers |
State | Issuer | Identifier | Type Code |
---|---|---|---|
CO | TAX ID# | 27-2331951 | 01 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1346479870 | Kelly Ann Wade | Speech-Language Pathologist | 58 Blackberry Dr, Hudson, OH 44236-4700 | 2009-07-06 |
1679801740 | Kelly L Wade | Case Manager/Care Coordinator | 1400 Hudson St, Elkhart, IN 46516-2023 | 2009-11-30 |
1902025034 | Kelly Baker Wade | Nurse Anesthetist, Certified Registered | 877 Jefferson Ave, Memphis, TN 38103-2807 | 2007-04-25 |
1194842237 | Kelly Rae Wade | Acupuncturist | 1800 Westlake Ave N Ste 203, Seattle, WA 98109-2782 | 2007-03-23 |
1811924723 | Kelly Wade | Pediatrics | 3401 Civic Center Blvd, Children's Hospital of Philadelphia - Neonatology, Philadelphia, PA 19104-4319 | 2006-06-27 |
Street Address |
130 EXECUTIVE CENTER PKWY |
City | FREDERICKSBURG |
State | VA |
Zip Code | 22401-3100 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1659322659 | Fu-yu Chiang | Internal Medicine | 130 Executive Center Pkwy, Fredericksburg, VA 22401-3100 | 2006-05-14 |
1558738807 | Leslie Kolbig | Pharmacist | 130 Executive Center Pkwy, Fredericksburg, VA 22401-3100 | 2015-08-21 |
1447650627 | Delisa Stanfill Showers | Nurse Practitioner | 130 Executive Center Pkwy, Hbpc, Fredericksburg, VA 22401-3100 | 2014-08-25 |
1225470065 | Saundra Delphine Mercer | Social Worker | 130 Executive Center Pkwy, Fredericksburg, VA 22401-3100 | 2013-07-22 |
1992090021 | Sangil Park | Psychiatry & Neurology | 130 Executive Center Pkwy, Fredericksburg, VA 22401-3100 | 2011-06-16 |
1497878961 | Brychan K.m. Clark | Internal Medicine | 130 Executive Center Pkwy, Mcguire Va Clinic Fredericksburg Cboc, Fredericksburg, VA 22401-3100 | 2007-04-09 |
1942226311 | Dolores A Lindblom | Counselor | 130 Executive Center Pkwy, Fredericksburg, VA 22401-3100 | 2006-07-15 |
1023058591 | Robert H Seamon | Internal Medicine | 130 Executive Center Pkwy, Fredericksburg, VA 22401-3100 | 2006-06-06 |
1093752099 | Richmond Vamc | Clinic/Center | 130 Executive Center Pkwy, Fredericksburg, VA 22401-3100 | 2006-05-31 |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1992313415 | Amanda Dodd | Behavior Technician | 1411 Princess Anne, Fredericksburg, VA 22401 | 2020-07-21 |
1215567326 | Britteny Whitaker | Behavior Technician | 1411 Princess Ann, Fredericksburg, VA 22401 | 2020-01-17 |
1396389433 | Ashley Stanevich | Behavior Technician | 1411 Princess Anne Lane, Fredericksburg, VA 22401 | 2019-11-01 |
1265074231 | Anna Kelleher | Behavior Technician | 1411 Princess Anna St, Frericksburg, VA 22401 | 2019-10-11 |
1649824152 | Zaan Z Ali | Audiologist | 1708 Fall Hill Ave Suite 100, Fredericksburg, VA 22401 | 2019-08-01 |
1790342426 | Michael Williams Jr. | Physician Assistant | 411 B Park Hill Dr, Frederickburg, VA 22401 | 2019-05-29 |
1285290965 | Ann Damalie Namabiro | Behavior Technician | 1411 Princess Ann Street, Fredericksburg, VA 22401 | 2019-05-17 |
1922579630 | Primary and Urgent Care LLC | Family Medicine | Primary and Urgent Care LLC, 2306 Plank Road Ste 100, Fredericksburg, VA 22401 | 2018-12-07 |
1003323056 | Mariah Mazzariello | Behavior Technician | 1411 Princess Anne Stree, Fredericksburg, VA 22401 | 2017-12-29 |
1336655281 | Hina Zafar | Behavior Technician | 1411 Princess Anne St., Fredericksburg, VA 22401 | 2017-12-14 |
Find all providers in zip 22401 |
Taxonomy Code | 103TC0700X |
Grouping | Behavioral Health & Social Service Providers |
Classification | Psychologist |
Specialization | Clinical |
Definition to come... |
NPI | Name | Taxonomy | Address | Enumeration |
---|---|---|---|---|
1649524604 | Sarah F Fischer-etu | Psychologist | 510 Princess Anne St Ste 101, Fredericksburg, VA 22401-6077 | 2012-10-30 |
1265798102 | Simply Counseling, LLC | Psychologist | 10500 Wakeman Dr Ste 240, Fredericksburg, VA 22407-8012 | 2012-04-04 |
1790093961 | Patrice J Berry | Psychologist | 615 Jefferson Davis Hwy, Ste 202, Fredericksburg, VA 22401-8407 | 2010-09-21 |
1568777621 | Elisabeth Margaret Jerome | Psychologist | 510 Princess Anne St, Suite 101, Fredericksburg, VA 22401-6077 | 2010-08-13 |
1467766386 | Robyn A Van Brunt | Psychologist | 615 Jefferson Davis Hwy Ste 101, Fredericksburg, VA 22401-8407 | 2010-08-03 |
1902074982 | Laurencia C.d.l. Dusantos | Psychologist | 904 Princess Anne St Ste 402, Fredericksburg, VA 22401-5804 | 2008-02-13 |
1538359054 | William Edward Lynch IIi | Psychologist | 4607 Harrison Rd, Fredericksburg, VA 22408-1838 | 2007-07-31 |
1245420819 | Cynthia Gustafson Repanshek | Psychologist | 404 Chatham Square Office Park, Fredericksburg, VA 22405-2544 | 2007-07-30 |
1003979428 | Peak Mental Health Services, Pllc | Psychologist | 1133 Heatherstone Dr Ste 102, Fredericksburg, VA 22407-4828 | 2006-12-18 |
1124197579 | Michelle Sjolinder | Psychologist | 4020 Plank Rd, Unit A, Fredericksburg, VA 22407-4800 | 2006-11-07 |
Find all providers in FREDERICKSBURG |
City | FREDERICKSBURG |
Zip Code | 22401 |
Please comment or provide details below to improve the information on DR. KELLY JENSEN WADE.
Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.