Active NPI
Jacqueline King
- Behavior Analyst
- Boise, ID
National Provider Identifier
1053077784
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 4232 N Waterford PL
Boise, ID 83703-3490 - Phone
- (804) 466-1323
- NPI assigned
- Nov 17, 2021
- Last updated
- Nov 17, 2021
- 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 Analyst | 103K00000X | Primary |
Addresses
Primary practice location
4232 N Waterford PL
Boise, ID 83703-3490
Mailing address
640 Grassmere Park Ste 116
Nashville, TN 37211-3678
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Autism Living Experience, LLC | Behavior Analyst | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1637107200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1637107200000",
"number": "1053077784",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "640 GRASSMERE PARK STE 116",
"city": "NASHVILLE",
"state": "TN",
"postal_code": "372113678"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4232 N WATERFORD PL",
"city": "BOISE",
"state": "ID",
"postal_code": "837033490",
"telephone_number": "804-466-1323"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KING",
"first_name": "JACQUELINE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-11-17",
"last_updated": "2021-11-17",
"certification_date": "2021-11-17",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Boise, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 17, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.