MEDICARE: WILSON PSYCHOLOGICAL ASSESSMENTS, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist

General Provider Information

NPI Number	:	1427903541
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	WILSON PSYCHOLOGICAL ASSESSMENTS, PLLC

Provider Business Mailing Address
First Line	:	417 E SILAS ST
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74003-3611
Country	:	US
Telephone Number	:	918-337-6050
Fax Number	:	918-337-6061

Provider Business Practice Location Address
First Line	:	417 E SILAS ST
Second Line	:
City	:	BARTLESVILLE
State	:	OK
Zip	:	74003-3611
Country	:	US
Telephone Number	:	918-337-6050
Fax Number	:	918-337-6061

Authorized Official
Title or Position	:	PSYCHOLOGIST
Name	:	DR. KENNETH SPENCER WILSON
Credential	:	PHD
Telephone Number	:	918-332-6375

Provider Enumeration Date	:	03/03/2026
Last Update Date	:	03/03/2026

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