Active NPI
Kendra Moon
- Behavior Technician
- Pooler, GA
National Provider Identifier
1083382790
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 105 Grand Central Blvd Ste 102103
Pooler, GA 31322-4148 - Phone
- (912) 446-2473
- NPI assigned
- Aug 30, 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 Technician | 106S00000X | Primary |
Addresses
Primary practice location
105 Grand Central Blvd Ste 102103
Pooler, GA 31322-4148
Mailing address
300 International Pkwy Ste 200
Lake Mary, FL 32746-5028
Phone (866) 610-0580
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": "1630281600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630281600000",
"number": "1083382790",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "300 INTERNATIONAL PKWY STE 200",
"city": "LAKE MARY",
"state": "FL",
"postal_code": "327465028",
"telephone_number": "866-610-0580"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "105 GRAND CENTRAL BLVD STE 102103",
"city": "POOLER",
"state": "GA",
"postal_code": "313224148",
"telephone_number": "912-446-2473"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOON",
"first_name": "KENDRA",
"name_prefix": "Miss",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-30",
"last_updated": "2021-08-30",
"certification_date": "2021-08-30",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Pooler, GA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 30, 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.