Active NPI
Kristen Holly Dickens
- Behavior Technician
- Mary Esther, FL
National Provider Identifier
1306320379
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 1865395
- Practice address
- 124 E Miracle Strip Pkwy Ste 502
Mary Esther, FL 32569-1991 - Phone
- (850) 301-0438
- Fax
- (844) 308-4990
- NPI assigned
- Sep 17, 2018
- 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 | 1865395 | FL | Primary |
Addresses
Primary practice location
124 E Miracle Strip Pkwy Ste 502
Mary Esther, FL 32569-1991
Mailing address
124 E Miracle Strip Pkwy Ste 502
Mary Esther, FL 32569-1991
Phone (850) 301-0438
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 |
|---|---|---|---|
| 1865395 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1537142400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1537142400000",
"number": "1306320379",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "124 E MIRACLE STRIP PKWY STE 502",
"city": "MARY ESTHER",
"state": "FL",
"postal_code": "325691991",
"telephone_number": "850-301-0438",
"fax_number": "844-308-4990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "124 E MIRACLE STRIP PKWY STE 502",
"city": "MARY ESTHER",
"state": "FL",
"postal_code": "325691991",
"telephone_number": "850-301-0438",
"fax_number": "844-308-4990"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DICKENS",
"first_name": "KRISTEN",
"middle_name": "HOLLY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-09-17",
"last_updated": "2018-09-17",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "1865395",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mary Esther, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 17, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.