Provider Demographics
NPI:1629026125
Name:HARPER, WAYNE JAMES (EDD)
Entity Type:Individual
Prefix:DR
First Name:WAYNE
Middle Name:JAMES
Last Name:HARPER
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 436503
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40253-6503
Mailing Address - Country:US
Mailing Address - Phone:502-882-1831
Mailing Address - Fax:502-365-3015
Practice Address - Street 1:138 EVERGREEN RD
Practice Address - Street 2:SUITE 105
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40243-1410
Practice Address - Country:US
Practice Address - Phone:502-882-1831
Practice Address - Fax:502-365-3015
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-05
Last Update Date:2014-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1069103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
090226000OtherWH MAGELLAN ANTHEM
KY1069OtherLICENSED PSYCHOLOGIST
312226OtherWH UBH CLAIMS UT
000000383490OtherWH ANTHEM FEP FED EMP PRO
0682204OtherWH ADMINISTAR FEDERAL
000000383490OtherWH BLUE CROSS BLUE SHIELD
611131420OtherWH CORPHEALTH CLAIMS
611131420OtherWH HUMANA CLAIMS OFC LEX
155537OtherWH VALUE OPTIONS INC
KY8901069800Medicaid
171301561OtherCIGNA HEALTH CARE
611131420OtherWH CORPHEALTH CLAIMS