KORTNEY DANIELLE WOOTEN (PHD) – Counseling Psychologist, NPI 1134940067

KORTNEY DANIELLE WOOTEN (PHD) is a healthcare provider. based in Lubbock, Texas. specializing in CLINICAL PSYCHOLOGIST. They hold the professional credentials PHD. They hold a License No. 40206 (TX). The NPI Number for KORTNEY DANIELLE WOOTEN (PHD) is 1134940067

Main info

Female
3 Years Of Experience
Accepts Medicare Assignment
Name
KORTNEY DANIELLE WOOTEN (PHD)
NPI
1134940067
Phone
(225) 328-7511
Address
2102 WEST LOOP 289
Enumeration Date
23 October 2024
Last Update Date
23 October 2024

Doctor Profile

Medical School Name
OTHER
Secondary Phone
8067303458
Graduation Year
2023 (3 years ago)
PAC ID
7113283235
Group Practice PAC ID
1759623465
Professional Enrollment ID
I20250221003583
Address ID
TX794231979LU4003XSTXX300
Data current as of
19 May 2026

Profile Insights

NPPES metrics only — not quality of care.

Methodology
Experience26
Completeness75
Years active:1State licenses:1Digital endpointsOther names

1,347 CLINICAL PSYCHOLOGIST in TX

Provider Addresses for KORTNEY DANIELLE WOOTEN (PHD)

  • 2102 WEST LOOP 289

    APARTMENT 104 BUILDING 23

    LUBBOCK, TX 79407

    Phone: (225) 328-7511

    Mailing address matches the actual address.

NPPES updates history

No NPPES updates recorded for this provider.

Prescription Activity

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Open Payments (CMS)

No Open Payments data available for this provider.

This can happen when there are no reportable CMS Open Payments records.

Medicare Enrollment & Revalidation

Source: CMS public data · Not endorsed by CMS ·

Educational use only—not medical, billing, or legal advice.

PECOS enrollment status

Participating (accepts Medicare assignment)

Enrollment effective: 2025-02-21

PECOS data refreshed: 2026-05-27

Medicare revalidation (CMS due date list)

Due date not assigned yet

CMS is tracking this Medicare enrollment for revalidation, but has not published a due date.

Enrollment records

1

Earliest due date

Not assigned (TBD)

CMS data updated

2026-06-01

Revalidation progress

  1. Medicare enrolled
  2. On CMS revalidation list
  3. Due date assigned
  4. Revalidate in PECOS

CMS enrollment records

Enrollment IDTypeSpecialtyStateDue date
I20250221003583IClinical PsychologistTXTBD

What to do next

  • No action required while the due date shows TBD.
  • Check the CMS Revalidation Lookup Tool periodically — CMS updates the list about every 60 days.
  • Do not submit a revalidation application in PECOS until CMS publishes a concrete due date.

Verify on CMS Revalidation Lookup Tool

Prepare CMS-855 application → · Look up this NPI in PECOS → · Verify on CMS PECOS

Medicare Utilization (FFS)

Source: CMS public data · Not endorsed by CMS · Beneficiary counts under 11 are suppressed in source data ·

Educational use only—not medical, billing, or legal advice.

No Medicare fee-for-service utilization data available for this provider in our database.

Insurance plans in this area (ZIP 79407)

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Group practice members

Group practice members are other physicians who share the same Group Practice PAC ID with this doctor. When doctors form a group practice and register in PECOS as a single entity, they receive a shared identification number. This table lists all providers in the same group practice.
PAC ID: 1759623465View full group profile
NameSpecialtyState
Nurse PractitionerTX
Mental Health CounselorTX
Nurse PractitionerTX
Physical Medicine And RehabilitationTX

Reviews

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Frequently asked questions

Is there an official ID for KORTNEY DANIELLE WOOTEN (PHD) in U.S. healthcare records?
The official identifier for KORTNEY DANIELLE WOOTEN (PHD) is NPI 1134940067.
Would KORTNEY DANIELLE WOOTEN (PHD) appear as active to a payer?
You can treat KORTNEY DANIELLE WOOTEN (PHD) as active for directory purposes; confirm clinical privileges separately.
What kind of doctor is KORTNEY DANIELLE WOOTEN (PHD)?
KORTNEY DANIELLE WOOTEN (PHD) is associated with Counseling Psychologist in the directory — Clinical services aligned with this taxonomy classification.
What practice footprint exists for KORTNEY DANIELLE WOOTEN (PHD)?
Travel planning: use Lubbock, Texas as the reference point for KORTNEY DANIELLE WOOTEN (PHD), then confirm.
Does inactive status remove historical data?
Historical rows can remain visible after status changes — read the dates carefully.

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