Active NPI
Kaylen Clark
- Behavior Technician
- Tucker, GA
National Provider Identifier
1013748235
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-24-368487
- Practice address
- 5072 Lavista Rd
Tucker, GA 30084-3500 - Phone
- (706) 842-5330
- Fax
- (706) 842-5340
- NPI assigned
- Aug 9, 2024
- Sex
- Female
- Sole proprietor
- No
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 Technician | 106S00000X | RBT-24-368487 | GA | Primary |
Addresses
Primary practice location
5072 Lavista Rd
Tucker, GA 30084-3500
Mailing address
209 7TH St FL 3
Augusta, GA 30901-1486
Phone (706) 842-5330
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 |
|---|---|---|---|
| RBT-24-368487 | GA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1723161600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1723161600000",
"number": "1013748235",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "209 7TH ST FL 3",
"city": "AUGUSTA",
"state": "GA",
"postal_code": "309011486",
"telephone_number": "706-842-5330",
"fax_number": "706-842-5340"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5072 LAVISTA RD",
"city": "TUCKER",
"state": "GA",
"postal_code": "300843500",
"telephone_number": "706-842-5330",
"fax_number": "706-842-5340"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KAYLEN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-08-09",
"last_updated": "2024-08-09",
"certification_date": "2024-08-09",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "GA",
"license": "RBT-24-368487",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Tucker, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 9, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.