Active NPI
Alyssa Nicole Bourque
- Behavior Analyst
- Slocomb, AL
National Provider Identifier
1104599257
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 612 S Watford Rd
Slocomb, AL 36375-6952 - Phone
- (334) 258-5482
- NPI assigned
- Jul 26, 2021
- 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 Analyst | 103K00000X | Primary |
Addresses
Primary practice location
612 S Watford Rd
Slocomb, AL 36375-6952
Mailing address
612 S Watford Rd
Slocomb, AL 36375-6952
Phone (334) 258-5482
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 54217716 | Medicaid | AL |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | gmail | Health Information Exchange (HIE) |
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": "1627257600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1627257600000",
"number": "1104599257",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "612 S WATFORD RD",
"city": "SLOCOMB",
"state": "AL",
"postal_code": "363756952",
"telephone_number": "334-258-5482"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "612 S WATFORD RD",
"city": "SLOCOMB",
"state": "AL",
"postal_code": "363756952",
"telephone_number": "334-258-5482"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BOURQUE",
"first_name": "ALYSSA",
"middle_name": "NICOLE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-07-26",
"last_updated": "2021-07-26",
"certification_date": "2021-07-26",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "54217716",
"state": "AL"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "gmail",
"affiliation": "N",
"endpointDescription": "gmail",
"use": "HIE",
"useDescription": "Health Information Exchange (HIE)",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "612 S Watford Rd",
"city": "Slocomb",
"state": "AL",
"country_code": "US",
"postal_code": "363756952",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Slocomb, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 26, 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.