DR. KEVIN S WEATHERLY PH.D.
NPI 1164785556
Psychologist in Greenville, TX

Active since June 20, 2012PECOS EnrolledAccepts Medicare Assignment
5604 WESLEY ST STE 104, GREENVILLE, TX 75402(903) 883-7792(903) 488-5303 Get Directions Write a Review

NPPES record last updated: July 6, 2023. Verified against the NPPES registry weekly; last sync: November 01, 2026.

Record update history: Jul 6, 2023, Apr 12, 2022, Mar 17, 2018 and 1 more (4 updates tracked since 2017).

About Dr. Kevin S Weatherly Ph.d. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

DR. KEVIN S WEATHERLY PH.D. (NPI 1164785556) is an individual psychologist in Greenville, Texas, licensed in Texas (37657) and active in the NPI registry since June 2012. He is enrolled in Medicare PECOS and is a graduate of Other (2014).

NPPES Registry Identity

NPI1164785556
Entity TypeIndividualMale
Primary Taxonomy103T00000X
Provider Legal NameDR. KEVIN S WEATHERLYCredential: PH.D.
Location Address5604 WESLEY ST STE 104Greenville, TX 75402-6326
Mailing Address5604 Wesley St Ste 104Greenville, TX 75402-6326 · (903) 883-7792 · Fax (903) 488-5303
Fax(903) 488-5303
Sole ProprietorYes
Medical School CMSOtherGraduated 2014
Enumeration DateJune 20, 2012
Last NPPES UpdateJuly 6, 20234 updates tracked since enumeration
NPPES CertifiedJuly 6, 2023
✔ NPI 1164785556 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyPsychologistBehavioral Health & Social Service Providers
Taxonomy Code103T00000X
License✔ Licensed in TX · 37657
Definition
A psychologist is an individual who is licensed to practice psychology which is defined as the observation, description, evaluation, interpretation, and modification of human behavior by the application of psychological principles, methods, and procedures, for the purpose of preventing or eliminating symptomatic, maladaptive, or undesired behavior and of enhancing interpersonal relationships, work and life adjustment, personal effectiveness, behavioral health, and mental health. The practice of psychology includes, but is not limited to, psychological testing and the evaluation or assessment of personal characteristics, such as intelligence, personality, abilities, interests, aptitudes, and neuropsychological functioning; counseling, psychoanalysis, psychotherapy, hypnosis, biofeedback, and behavior analysis and therapy; diagnosis and treatment of mental and emotional disorder or disability, alcoholism and substance abuse, disorders of habit or conduct, as well as of the psychological aspects of physical illness, accident, injury, or disability; and psycheducational evaluation, therapy, remediation, and consultation. Psychological services may be rendered to individuals, families, groups and the public.
Also ListedPsychologist · ClinicalTaxonomy 103TC0700X · License 37657 (TX)
5604 WESLEY ST STE 104, Greenville, TX 75402

Other Identifiers 1

Medicaid375679301TX

Accepted Insurance

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Dr. Kevin S Weatherly Ph.d. is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID6709150261
PECOS Enrollment IDI20170921001813
Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment– Home Health Agency– Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Frequently Asked Questions NPPES & CMS

Common questions about this NPI record, answered from the official NPPES registry and CMS datasets shown on this page.

What is Kevin Weatherly's NPI number?

The NPI number for Kevin Weatherly is 1164785556. It was assigned to this individual provider in the NPPES registry on June 20, 2012.

Where is Kevin Weatherly located?

Kevin Weatherly practices at 5604 Wesley St Ste 104, Greenville, TX 75402. The listed phone number is (903) 883-7792.

What is Kevin Weatherly's specialty?

The primary specialty registered for this NPI is Psychologist with taxonomy code 103T00000X.

Is Kevin Weatherly enrolled in Medicare?

Yes. Kevin Weatherly is registered in the Medicare PECOS system and accepts Medicare assignment, which means accepting the Medicare-approved amount as payment in full for covered services.

What insurance does Kevin Weatherly accept?

Health plans from Ambetter from Arizona Complete Health, Ambetter from Arkansas Health & Wellness, Ambetter from Louisiana Healthcare Connections, Ambetter from Superior HealthPlan and Ambetter of Oklahoma and 5 other insurers list Kevin Weatherly as in-network in at least one marketplace plan. Coverage varies by plan and year; verify with the insurer or the provider before a visit.

When was this NPI record last updated?

The NPPES record for Kevin Weatherly was last updated on July 6, 2023. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 3 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.