Active NPI
Jacqulyn Johnson
- Behavior Technician
- Fayetteville, NC
National Provider Identifier
1033070685
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 25-488674
- Practice address
- 345 Devers St Ste And102
Fayetteville, NC 28303-4752 - Phone
- (888) 392-8642
- NPI assigned
- Nov 22, 2025
- 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 | 25-488674 | Primary |
Addresses
Primary practice location
345 Devers St Ste And102
Fayetteville, NC 28303-4752
Mailing address
145 E Carver Dr
Meridian, ID 83646-4009
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1763769600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1763769600000",
"number": "1033070685",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 E CARVER DR",
"city": "MERIDIAN",
"state": "ID",
"postal_code": "836464009"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "345 DEVERS ST STE AND102",
"city": "FAYETTEVILLE",
"state": "NC",
"postal_code": "283034752",
"telephone_number": "888-392-8642"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JOHNSON",
"first_name": "JACQULYN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-11-22",
"last_updated": "2025-11-22",
"certification_date": "2025-11-22",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": "25-488674",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fayetteville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 22, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.