Jasmine Taylor Broadnax, BSL

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

AA0001811151 Issued in PA

Practice address

467 Creamery Way
Exton, PA 19341-2508

Phone

(610) 594-0278

NPI assigned

Dec 20, 2019

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Bachelor of Science - Law

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1576800000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576800000000",
    "number": "1013555002",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1119 WYNNBROOK RD",
            "city": "SECANE",
            "state": "PA",
            "postal_code": "190183516",
            "telephone_number": "215-834-2765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "467 CREAMERY WAY",
            "city": "EXTON",
            "state": "PA",
            "postal_code": "193412508",
            "telephone_number": "610-594-0278"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROADNAX",
        "first_name": "JASMINE",
        "middle_name": "TAYLOR",
        "credential": "BSL",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2019-12-20",
        "last_updated": "2019-12-20",
        "certification_date": "2019-12-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": "PA",
            "license": "AA0001811151",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Behavior Technician in Exton, PA
• Providers in Exton, PA by specialty
• Behavior Technician in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 20, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.