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KIMBERLY JOY WILSON
NPI 1760003958
Counselor - Mental Health in Vancouver, WA

Active since April 29, 2020PECOS EnrolledAccepts Medicare Assignment
11105 NE 14TH ST STE 103, VANCOUVER, WA 98684(503) 850-8088 Get Directions Write a Review

NPPES record last updated: December 26, 2023. Verified against the NPPES registry weekly; last sync: July 26, 2026.

About Kimberly Joy Wilson NPPES

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

KIMBERLY JOY WILSON (NPI 1760003958) is an individual mental health provider in Vancouver, Washington, licensed in Oregon (R7572) and active in the NPI registry since April 2020. She is enrolled in Medicare PECOS, maintains a secondary practice location in Portland, and is a graduate of Other (2022).

NPPES Registry Identity

NPI1760003958
Entity TypeIndividualFemale
Primary Taxonomy101YM0800X
Provider Legal NameKIMBERLY JOY WILSON
Location Address11105 NE 14TH ST STE 103Vancouver, WA 98684-4309
Mailing Address11192 Se 52nd CtPortland, OR 97222-3500 · (503) 850-8088
Phone(503) 850-8088
Sole ProprietorYes
Medical School CMSOtherGraduated 2022
Enumeration DateApril 29, 2020
Last NPPES UpdateDecember 26, 2023
NPPES CertifiedDecember 26, 2023
✔ NPI 1760003958 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

★ Primary SpecialtyCounselor · Mental HealthBehavioral Health & Social Service Providers
Taxonomy Code101YM0800X
Licenses✔ Licensed in OR · R7572✔ Licensed in WA · MC61308406
11105 NE 14TH ST STE 103, Vancouver, WA 98684
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Secondary Practice Location 1

Location 111192 SE 52nd CtPortland, OR 97222-3500 · Phone (503) 850-8088

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

Kimberly Joy Wilson 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 ID2264921394
PECOS Enrollment IDI20251029003108
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.

Other Providers at the Same Location NPPES 7

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

HANNAH G MARTIN
Counselor (Mental Health)
11105 NE 14TH ST STE 103
VANCOUVER, WA 98684
Clark County (360) 251-0902
TINA REMACLE LMHC
Counselor (Mental Health)
11105 NE 14TH ST STE 103
VANCOUVER, WA 98684
Clark County (503) 575-7134
MRS. ELIZABETH ANN MONROE LMT, LME
Massage Therapist
11105 NE 14TH ST STE 103
VANCOUVER, WA 98684
Clark County (971) 204-8772
JEREMIAH PECK
Counselor (Mental Health)
11105 NE 14TH ST STE 103
VANCOUVER, WA 98684
Clark County (360) 836-0320
HOPE RENEE FARMER
Counselor (Mental Health)
11105 NE 14TH ST STE 103
VANCOUVER, WA 98684
Clark County (360) 336-6383
PRESTON BRENNAN
Counselor (Mental Health)
11105 NE 14TH ST STE 103
VANCOUVER, WA 98684
Clark County (336) 817-1542
COMPASS CHRISTIAN COUNSELING
Clinic/Center (Mental Health (Including Community Mental Health Center))
11105 NE 14TH ST STE 103
VANCOUVER, WA 98684
Clark County (360) 216-9918

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 Kimberly Wilson's NPI number?

The NPI number for Kimberly Wilson is 1760003958. It was assigned to this individual provider in the NPPES registry on April 29, 2020.

Where is Kimberly Wilson located?

Kimberly Wilson practices at 11105 NE 14th St Ste 103, Vancouver, WA 98684. The listed phone number is (503) 850-8088.

What is Kimberly Wilson's specialty?

The primary specialty registered for this NPI is Counselor, specializing in Mental Health, with taxonomy code 101YM0800X.

Is Kimberly Wilson enrolled in Medicare?

Yes. Kimberly Wilson 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.

When was this NPI record last updated?

The NPPES record for Kimberly Wilson was last updated on December 26, 2023. NPI Profile syncs with the weekly NPPES data releases published by CMS.