Active NPI
Takiylah Kelis Nichols
- Behavior Technician
- Memphis, TN
National Provider Identifier
1194638189
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-26-2841242
- Practice address
- 4075 Park Ave
Memphis, TN 38111-7400 - Phone
- (901) 584-8281
- NPI assigned
- Sep 23, 2026
- 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 | RBT-26-2841242 | TN | Primary |
Addresses
Primary practice location
4075 Park Ave
Memphis, TN 38111-7400
Mailing address
4139 Tarrywood Dr Apt 4
Memphis, TN 38118-8319
Phone (901) 506-6756
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1790121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1790121600000",
"number": "1194638189",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4139 TARRYWOOD DR APT 4",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381188319",
"telephone_number": "901-506-6756"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4075 PARK AVE",
"city": "MEMPHIS",
"state": "TN",
"postal_code": "381117400",
"telephone_number": "901-584-8281"
}
],
"practiceLocations": [],
"basic": {
"last_name": "NICHOLS",
"first_name": "TAKIYLAH",
"middle_name": "KELIS",
"name_prefix": "Ms.",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2026-09-23",
"last_updated": "2026-09-23",
"certification_date": "2026-09-23",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "TN",
"license": "RBT-26-2841242",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Memphis, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.