Healthcare Provider Details

I. General information

NPI: 1144326265
Provider Name (Legal Business Name): WILSON PSYCHOLOGICAL ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2006
Last Update Date: 09/21/2023
Certification Date:
Deactivation Date: 09/06/2023
Reactivation Date: 09/21/2023

III. Provider practice location address

501 S JOHNSTONE AVE SUITE 503
BARTLESVILLE OK
74003-6622
US

IV. Provider business mailing address

501 S JOHNSTONE AVE SUITE 503
BARTLESVILLE OK
74003-6622
US

V. Phone/Fax

Practice location:
  • Phone: 918-337-6050
  • Fax: 918-337-6061
Mailing address:
  • Phone: 918-337-6050
  • Fax: 918-337-6061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number966
License Number StateOK

VIII. Authorized Official

Name: DR. KENNETH SPENCER WILSON
Title or Position: PSYCHOLOGIST
Credential: PHD
Phone: 918-337-6050