Kelly Anders
Individual provider Active NPI Behavior Analyst · Wright City, MO
NPI 1063969103 · NPPES record last updated Sep 7, 2016
Key facts
- NPI
- 1063969103
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- License
- 2015015155 (MO)
- Practice address
- 1000 Moon Valley LN
Wright City, MO 63390-2114 - Phone
- (314) 265-0336
- NPI assigned
- Sep 7, 2016
- Sex
- Female
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2015015155 | MO | MD | Behavioral Analyst |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 2015015155 | MO | Yes |
Addresses
Primary practice location
1000 Moon Valley LN
Wright City, MO 63390-2114
Mailing address
1000 Moon Valley LN
Wright City, MO 63390-2114
Phone (314) 265-0336
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All providers in Wright City, MO · Behavior Analyst in Missouri
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Sep 7, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.