Active NPI
Jennifer Blythe Reno-Medeiros, RBT
- Behavior Technician
- Keaau, HI
National Provider Identifier
1215624929
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-21-192529
- Practice address
- 15-1560 29TH Avenue
Keaau, HI 96749-9674 - Phone
- (808) 333-6443
- NPI assigned
- Apr 21, 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 | RBT-21-192529 | HI | Primary |
Addresses
Primary practice location
15-1560 29TH Avenue
Keaau, HI 96749-9674
Mailing address
HC 1 Box 5063
Keaau, HI 96749-9504
Phone (808) 333-6443
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 |
|---|---|---|---|
| RBT-21-192529 | HI | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1682035200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1682035200000",
"number": "1215624929",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "HC 1 BOX 5063",
"city": "KEAAU",
"state": "HI",
"postal_code": "967499504",
"telephone_number": "808-333-6443"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15-1560 29TH AVENUE",
"city": "KEAAU",
"state": "HI",
"postal_code": "967499674",
"telephone_number": "808-333-6443"
}
],
"practiceLocations": [],
"basic": {
"last_name": "RENO-MEDEIROS",
"first_name": "JENNIFER",
"middle_name": "BLYTHE",
"credential": "RBT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-04-21",
"last_updated": "2023-04-21",
"certification_date": "2023-04-15",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "HI",
"license": "RBT-21-192529",
"primary": true
}
],
"identifiers": [],
"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 Apr 21, 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.