Active NPI
Nicole Victoria Kenyon
- Behavior Analyst
- Port St Lucie, FL
National Provider Identifier
1013405653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1194252163
- Practice address
- 602 SE Starflower Ave
Port St Lucie, FL 34983-4635 - Phone
- (973) 934-6356
- NPI assigned
- Apr 30, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1194252163 | FL | Primary |
Addresses
Primary practice location
602 SE Starflower Ave
Port St Lucie, FL 34983-4635
Mailing address
602 SE Starflower Ave
Port St Lucie, FL 34983-4635
Phone (973) 934-6356
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1194252163 | FL | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1525046400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1525046400000",
"number": "1013405653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "602 SE STARFLOWER AVE",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349834635",
"telephone_number": "973-934-6356"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "602 SE STARFLOWER AVE",
"city": "PORT ST LUCIE",
"state": "FL",
"postal_code": "349834635",
"telephone_number": "973-934-6356"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KENYON",
"first_name": "NICOLE",
"middle_name": "VICTORIA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-04-30",
"last_updated": "2018-04-30",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "FL",
"license": "1194252163",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Port St Lucie, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.