Active NPI
Courtney Ketter
- Behavior Analyst
- North Las Vegas, NV
National Provider Identifier
1154615227
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 3455 W Craig Rd Ste C
North Las Vegas, NV 89032-5119 - Phone
- (702) 518-4337
- NPI assigned
- Jun 6, 2011
- Sex
- Male
- 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 Analyst | 103K00000X | Primary |
Addresses
Primary practice location
3455 W Craig Rd Ste C
North Las Vegas, NV 89032-5119
Mailing address
6905 Diver Ave
North Las Vegas, NV 89084-3103
Phone (310) 409-5882
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1134362056 | Medicaid | NV |
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": "1307318400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1307318400000",
"number": "1154615227",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6905 DIVER AVE",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890843103",
"telephone_number": "310-409-5882"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "3455 W CRAIG RD STE C",
"city": "NORTH LAS VEGAS",
"state": "NV",
"postal_code": "890325119",
"telephone_number": "702-518-4337"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KETTER",
"first_name": "COURTNEY",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2011-06-06",
"last_updated": "2011-06-06",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1134362056",
"state": "NV"
}
],
"endpoints": [],
"other_names": []
}Other providers in North Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 6, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.