Active NPI
Alexis Marie Chidester
- Behavior Technician
- Gonzales, LA
National Provider Identifier
1316636459
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 012530305
- Practice address
- 1028 E Worthy St
Gonzales, LA 70737-4367 - Phone
- (504) 399-9851
- NPI assigned
- May 4, 2023
- 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 | 012530305 | LA | Primary |
Addresses
Primary practice location
1028 E Worthy St
Gonzales, LA 70737-4367
Mailing address
1028 E Worthy St
Gonzales, LA 70737-4367
Phone (504) 399-9851
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 |
|---|---|---|---|
| 012530305 | LA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1683158400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683158400000",
"number": "1316636459",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1028 E WORTHY ST",
"city": "GONZALES",
"state": "LA",
"postal_code": "707374367",
"telephone_number": "504-399-9851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1028 E WORTHY ST",
"city": "GONZALES",
"state": "LA",
"postal_code": "707374367",
"telephone_number": "504-399-9851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CHIDESTER",
"first_name": "ALEXIS",
"middle_name": "MARIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-05-04",
"last_updated": "2023-05-04",
"certification_date": "2023-05-04",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "LA",
"license": "012530305",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gonzales, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 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.