Individual provider Active NPI

Rodney Evan Isaiah Broughton

  • Behavior Technician
  • Louisville, KY
National Provider Identifier
1114720901
Registry record updated Mar 28, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
Practice address
1230 Liberty Bank LN Ste 330
Louisville, KY 40222-5756
Phone
(859) 207-3830
NPI assigned
Mar 28, 2025
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 28, 2025

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Primary

Addresses

Primary practice location

1230 Liberty Bank LN Ste 330
Louisville, KY 40222-5756

Mailing address

10422 Monticello Forest Cir
Louisville, KY 40299-4129
Phone (636) 493-4078

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": "1743120000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1743120000000",
    "number": "1114720901",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10422 MONTICELLO FOREST CIR",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402994129",
            "telephone_number": "636-493-4078"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1230 LIBERTY BANK LN STE 330",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402225756",
            "telephone_number": "859-207-3830"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BROUGHTON",
        "first_name": "RODNEY",
        "middle_name": "EVAN ISAIAH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2025-03-28",
        "last_updated": "2025-03-28",
        "certification_date": "2025-03-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Louisville, KY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 28, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.