Ryder Moira Nicholas

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

107 RR 620 S Ste 300
Lakeway, TX 78734-3900

Phone

(512) 717-4788

Fax

(512) 519-8742

NPI assigned

Aug 12, 2019

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1565568000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1565568000000",
    "number": "1265088686",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "107 RR 620 S STE 300",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787343900",
            "telephone_number": "512-717-4788",
            "fax_number": "512-519-8742"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "107 RR 620 S STE 300",
            "city": "LAKEWAY",
            "state": "TX",
            "postal_code": "787343900",
            "telephone_number": "512-717-4788",
            "fax_number": "512-519-8742"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NICHOLAS",
        "first_name": "RYDER",
        "middle_name": "MOIRA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-08-12",
        "last_updated": "2019-08-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "TID",
            "identifier": "822465485",
            "state": "TX"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "www.bluesprigautism.com",
            "affiliation": "N",
            "endpointDescription": "website",
            "address_1": "107 RR 620 S",
            "city": "Lakeway",
            "state": "TX",
            "country_code": "US",
            "postal_code": "787343942",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Behavior Technician in Lakeway, TX
• Providers in Lakeway, TX by specialty
• Behavior Technician in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 12, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.