DR. KELLY JENSEN WADE


Address: 130 Executive Center Pkwy, Fredericksburg, VA 22401-3100
Phone: 5403704468

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).

Provider Overview

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

Taxonomy

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

Other Provider Identifier

State Issuer Identifier Type Code
CO TAX ID# 27-2331951 01

Other Providers KELLY WADE

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

Office Location

Street Address 130 EXECUTIVE CENTER PKWY
City FREDERICKSBURG
State VA
Zip Code 22401-3100

Providers in the same location

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

Providers in the same zip code

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 Information

Taxonomy Code 103TC0700X
Grouping Behavioral Health & Social Service Providers
Classification Psychologist
Specialization Clinical

Taxonomy Definition

Definition to come...

Providers in the same taxonomy and city

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

Competitor

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City FREDERICKSBURG
Zip Code 22401

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Dataset Information

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.

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