Active NPI
Kaylin Melissa Moss
- Behavior Analyst
- Wellington, FL
National Provider Identifier
1184075483
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-19-40133
- Practice address
- 11907 Sturbridge LN
Wellington, FL 33414-5715 - Phone
- (561) 301-8330
- NPI assigned
- Jun 28, 2016
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Developmental Therapist | 222Q00000X | FL | ||
| Behavior Analyst | 103K00000X | 1-19-40133 | FL | Primary |
Addresses
Primary practice location
11907 Sturbridge LN
Wellington, FL 33414-5715
Mailing address
11907 Sturbridge LN
Wellington, FL 33414-5715
Phone (561) 301-8330
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 017975700 | Medicaid | FL | |
| 110018700 | Medicaid | FL |
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": "1467072000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1648512000000",
"number": "1184075483",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "11907 STURBRIDGE LN",
"city": "WELLINGTON",
"state": "FL",
"postal_code": "334145715",
"telephone_number": "561-301-8330"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "11907 STURBRIDGE LN",
"city": "WELLINGTON",
"state": "FL",
"postal_code": "334145715",
"telephone_number": "561-301-8330"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MOSS",
"first_name": "KAYLIN",
"middle_name": "MELISSA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2016-06-28",
"last_updated": "2022-03-29",
"certification_date": "2022-03-29",
"status": "A"
},
"taxonomies": [
{
"code": "222Q00000X",
"taxonomy_group": "",
"desc": "Developmental Therapist",
"state": "FL",
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "FL",
"license": "1-19-40133",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "017975700",
"state": "FL"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "110018700",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Wellington, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 29, 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.