Active NPI
Keenan Luster
- Behavior Technician
- Cordova, TN
National Provider Identifier
1083084842
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 146 Timber Creek Dr Ste 101
Cordova, TN 38018-4396 - Phone
- (901) 249-7838
- NPI assigned
- Oct 5, 2015
- Sex
- Female
- Sole proprietor
- Yes
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 | TN | Primary |
Addresses
Primary practice location
146 Timber Creek Dr Ste 101
Cordova, TN 38018-4396
Mailing address
146 Timber Creek Dr Ste 101
Cordova, TN 38018-4396
Phone (901) 249-7838
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1245764927 | Other | NA |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | amy.bohannan@shapingbehavior.org | Direct |
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 |
|---|---|---|---|
| Therapy Providers, P.a. | Single Specialty | 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 and National Provider Directory roles.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1444003200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1577923200000",
"number": "1083084842",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "146 TIMBER CREEK DR STE 101",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380184396",
"telephone_number": "901-249-7838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "146 TIMBER CREEK DR STE 101",
"city": "CORDOVA",
"state": "TN",
"postal_code": "380184396",
"telephone_number": "901-249-7838"
}
],
"practiceLocations": [],
"basic": {
"last_name": "LUSTER",
"first_name": "KEENAN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2015-10-05",
"last_updated": "2020-01-02",
"certification_date": "2020-01-02",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Behavior Technician",
"state": "TN",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NA",
"identifier": "1245764927",
"state": null
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "amy.bohannan@shapingbehavior.org",
"affiliation": "N",
"endpointDescription": "Owner",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "OTHER",
"contentTypeDescription": "Other",
"contentOtherDescription": "PDF",
"address_1": "146 Timber Creek Dr Ste 101",
"city": "Cordova",
"state": "TN",
"country_code": "US",
"postal_code": "380184396",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Cordova, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.