Active NPI
Jelisa Phillippi
- Behavior Analyst
- Fargo, ND
National Provider Identifier
1316475908
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-17-28640
- Practice address
- 112 University Dr N Ste 300
Fargo, ND 58102-4661 - Phone
- (701) 388-9345
- NPI assigned
- May 26, 2017
- Last updated
- Apr 21, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Specialist | 174400000X | NU | ||
| Behavior Analyst | 103K00000X | 1-17-28640 | NU | Primary |
Addresses
Primary practice location
112 University Dr N Ste 300
Fargo, ND 58102-4661
Mailing address
112 University Dr N Ste 300
Fargo, ND 58102-4661
Phone (701) 388-9345
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1-17-28640 | Other | BEHAVIOR ANALYST CERTIFICATION BOARD |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1495756800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1587427200000",
"number": "1316475908",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "112 UNIVERSITY DR N STE 300",
"city": "FARGO",
"state": "ND",
"postal_code": "581024661",
"telephone_number": "701-388-9345"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "112 UNIVERSITY DR N STE 300",
"city": "FARGO",
"state": "ND",
"postal_code": "581024661",
"telephone_number": "701-388-9345"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHILLIPPI",
"first_name": "JELISA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2017-05-26",
"last_updated": "2020-04-21",
"certification_date": "2020-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "174400000X",
"taxonomy_group": "",
"desc": "Specialist",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NU",
"license": "1-17-28640",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEHAVIOR ANALYST CERTIFICATION BOARD",
"identifier": "1-17-28640",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Fargo, ND
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.