Healthcare Provider Details

I. General information

NPI: 1033447024
Provider Name (Legal Business Name): WADE THOMAS KECKLER PSY.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/02/2009
Last Update Date: 05/23/2025
Certification Date: 05/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6000 W HIGHWAY 98
PENSACOLA FL
32512-0001
US

IV. Provider business mailing address

NAVAL HOSPITAL PENSACOLA 6000 WEST HIGHWAY 98
PENSACOLA FL
32512-0001
US

V. Phone/Fax

Practice location:
  • Phone: 850-505-6900
  • Fax:
Mailing address:
  • Phone: 850-505-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number8045
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: