Active NPI
Phylicia Nikole Gillespie
- Behavior Technician
- Raleigh, NC
National Provider Identifier
1134867773
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 000039889036
- Practice address
- 4511 Mimosa Tree LN Apt 1201
Raleigh, NC 27612-7063 - Phone
- (919) 308-3878
- NPI assigned
- May 24, 2022
- 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 | 000039889036 | NC | Primary |
Addresses
Primary practice location
4511 Mimosa Tree LN Apt 1201
Raleigh, NC 27612-7063
Mailing address
4511 Mimosa Tree LN Apt 1201
Raleigh, NC 27612-7063
Phone (919) 308-3878
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 000039889036 | NC | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1653350400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1653350400000",
"number": "1134867773",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4511 MIMOSA TREE LN APT 1201",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276127063",
"telephone_number": "919-308-3878"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4511 MIMOSA TREE LN APT 1201",
"city": "RALEIGH",
"state": "NC",
"postal_code": "276127063",
"telephone_number": "919-308-3878"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GILLESPIE",
"first_name": "PHYLICIA",
"middle_name": "NIKOLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-24",
"last_updated": "2022-05-24",
"certification_date": "2022-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "NC",
"license": "000039889036",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Raleigh, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.