1. Home
  2. Directory
  3. California
  4. Sacramento
  5. Psychologist
  6. NPI Profile

KELLY WILD PSY.D.
NPI 1609436906
Psychologist - Clinical in Sacramento, CA

Active since June 18, 2019PECOS Enrolled
1011 22ND ST, SACRAMENTO, CA 95816(916) 284-1416 Get Directions Write a Review

NPPES record last updated: March 28, 2025. Verified against the NPPES registry weekly; last sync: August 16, 2026.

Record update history: Mar 28, 2025, Jun 18, 2019 (2 updates tracked since 2019).

About Kelly Wild Psy.d. NPPES

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

KELLY WILD PSY.D. (NPI 1609436906) is an individual clinical provider in Sacramento, California, licensed in California (35793) and active in the NPI registry since June 2019. She is enrolled in Medicare PECOS and is a graduate of Other (2022).

NPPES Registry Identity

NPI1609436906
Entity TypeIndividualFemale
Primary Taxonomy103TC0700X
Provider Legal NameKELLY WILDCredential: PSY.D.
Location Address1011 22ND STSacramento, CA 95816-4907
Mailing Address2131 Capitol Ave Ste 206Sacramento, CA 95816-5755 · (916) 284-1416
Phone(916) 284-1416
Sole ProprietorNo
Medical School CMSOtherGraduated 2022
Enumeration DateJune 18, 2019
Last NPPES UpdateMarch 28, 20252 updates tracked since enumeration
NPPES CertifiedMarch 28, 2025
✔ NPI 1609436906 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyPsychologist · ClinicalBehavioral Health & Social Service Providers
Taxonomy Code103TC0700X
License✔ Licensed in CA · 35793
Definition
A psychologist who provides continuing and comprehensive mental and behavioral health care for individuals and families; consultation to agencies and communities; training, education and supervision; and research-based practice. It is a specialty in breadth -- one that is broadly inclusive of severe psychopathology -- and marked by comprehensiveness and integration of knowledge and skill from a broad array of disciplines within and outside of psychology proper. The scope of clinical psychology encompasses all ages, multiple diversities and varied systems.
1011 22ND ST, Sacramento, CA 95816
Open in Google Maps ↗

Other Names 1

Former Name (1)Ms. Kelly Gill

Medicare Participation & PECOS CMS

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

Medicare Enrollment Status

✔

Enrolled in Medicare (PECOS)

Kelly Wild Psy.d. is registered in the CMS Provider Enrollment, Chain and Ownership System (PECOS).

PECOS PAC ID3971028366
PECOS Enrollment IDI20250417003079
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.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 95816 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient
$180.85 typical visit price
range $60.44 – $180.85
Typical copayment $45.21 (range $15.11 – $45.21)
Most-billed visit code 99205
Established Patient
$105.95 typical visit price
range $19.88 – $148.15
Typical copayment $26.48 (range $4.97 – $37.03)
Most-billed visit code 99214
Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 15

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

KYLE MYERS
Marriage & Family Therapist
1011 22ND ST
SACRAMENTO, CA 95816
Sacramento County (916) 284-1416
TASHNA WARD
Marriage & Family Therapist
1011 22ND ST
SACRAMENTO, CA 95816
Sacramento County (707) 704-2465
SOPHIA MILLER
Psychologist (Clinical)
1011 22ND ST
SACRAMENTO, CA 95816
Sacramento County (916) 284-1416
DR. KATIE BAUTCH
Psychologist (Clinical)
1011 22ND ST
SACRAMENTO, CA 95816
Sacramento County (916) 905-7012
VANTAGE POINT CENTER FOR PSYCHOTHERAPY
Counselor (Mental Health)
1011 22ND ST
SACRAMENTO, CA 95816
Sacramento County (916) 284-1416
NAZANIN KHATAMI
Student in an Organized Health Care Education/Training Program
1011 22ND ST
SACRAMENTO, CA 95816
Sacramento County (916) 284-1416
DR. TRISHA D WALLIS, PSYCHOLOGIST, APC
Psychologist (Clinical)
1011 22ND ST
SACRAMENTO, CA 95816
Sacramento County (916) 996-5424
LARRY WASSON III
Psychologist (Clinical)
1011 22ND ST
SACRAMENTO, CA 95816
Sacramento County (305) 933-8172

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 Kelly Wild's NPI number?

The NPI number for Kelly Wild is 1609436906. It was assigned to this individual provider in the NPPES registry on June 18, 2019. The provider is also known as Ms. Kelly Gill.

Where is Kelly Wild located?

Kelly Wild practices at 1011 22nd St, Sacramento, CA 95816. The listed phone number is (916) 284-1416.

What is Kelly Wild's specialty?

The primary specialty registered for this NPI is Psychologist, specializing in Clinical, with taxonomy code 103TC0700X.

Is Kelly Wild enrolled in Medicare?

Yes. Kelly Wild is registered in the Medicare PECOS enrollment system.

When was this NPI record last updated?

The NPPES record for Kelly Wild was last updated on March 28, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 16 months 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.