Active NPI
Dezirae Butler
- Behavior Technician
- Stuart, FL
National Provider Identifier
1174215495
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 22231037
- Practice address
- 7108 S Kanner Hwy
Stuart, FL 34997-7462 - Phone
- (855) 832-6727
- Fax
- (772) 675-9100
- NPI assigned
- May 24, 2023
- Last updated
- May 24, 2023
- 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 Technician | 106S00000X | 22231037 | FL | Primary |
Addresses
Primary practice location
7108 S Kanner Hwy
Stuart, FL 34997-7462
Mailing address
854 Wilmington LN
Orange Park, FL 32065-2208
Phone (860) 938-5404
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 |
|---|---|---|---|
| 22231037 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1684886400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1684886400000",
"number": "1174215495",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "854 WILMINGTON LN",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320652208",
"telephone_number": "860-938-5404"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "7108 S KANNER HWY",
"city": "STUART",
"state": "FL",
"postal_code": "349977462",
"telephone_number": "855-832-6727",
"fax_number": "772-675-9100"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BUTLER",
"first_name": "DEZIRAE",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-05-24",
"last_updated": "2023-05-24",
"certification_date": "2023-05-24",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "22231037",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Stuart, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 24, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.