Active NPI
Tifanee A Smart
- Behavior Technician
- Keaau, HI
National Provider Identifier
1194442194
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- BACB527323
- Practice address
- 16-565 Keaau Pahoa Rd
Keaau, HI 96749-8113 - Phone
- (808) 313-4862
- NPI assigned
- Oct 20, 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 | BACB527323 | HI | Primary |
Addresses
Primary practice location
16-565 Keaau Pahoa Rd
Keaau, HI 96749-8113
Mailing address
12-243 W Pohakupele Loop
Pahoa, HI 96778-7863
Phone (808) 825-0616
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 20315536 | Medicaid | HI |
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 |
|---|---|---|---|
| BACB527323 | HI | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1666224000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1666224000000",
"number": "1194442194",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12-243 W POHAKUPELE LOOP",
"city": "PAHOA",
"state": "HI",
"postal_code": "967787863",
"telephone_number": "808-825-0616"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "16-565 KEAAU PAHOA RD",
"city": "KEAAU",
"state": "HI",
"postal_code": "967498113",
"telephone_number": "808-313-4862"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SMART",
"first_name": "TIFANEE",
"middle_name": "A",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-10-20",
"last_updated": "2022-10-20",
"certification_date": "2022-10-20",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "HI",
"license": "BACB527323",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "20315536",
"state": "HI"
}
],
"endpoints": [],
"other_names": []
}Other providers in Keaau, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 20, 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.