Active NPI
Makenzie McConnell
- Behavior Analyst
- Jacksonville, FL
National Provider Identifier
1336752153
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 12724 Gran Bay Pkwy W Ste 410
Jacksonville, FL 32258-9486 - Phone
- (855) 832-6727
- NPI assigned
- Aug 31, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | |||
| Behavior Analyst | 103K00000X | MI | Primary |
Addresses
Primary practice location
12724 Gran Bay Pkwy W Ste 410
Jacksonville, FL 32258-9486
Mailing address
7110 Michigan Rd
Bay City, MI 48706-9310
Phone (989) 415-9289
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1336752153 | Medicaid | MI |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Direct Messaging Address | kcrowell@teampbs.com | Direct |
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": "1598832000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1654128000000",
"number": "1336752153",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7110 MICHIGAN RD",
"city": "BAY CITY",
"state": "MI",
"postal_code": "487069310",
"telephone_number": "989-415-9289"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12724 GRAN BAY PKWY W STE 410",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322589486",
"telephone_number": "855-832-6727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MCCONNELL",
"first_name": "MAKENZIE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-08-31",
"last_updated": "2022-06-02",
"certification_date": "2022-06-02",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MI",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "1336752153",
"state": "MI"
}
],
"endpoints": [
{
"endpointType": "DIRECT",
"endpointTypeDescription": "Direct Messaging Address",
"endpoint": "kcrowell@teampbs.com",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "12724 Gran Bay Pkwy W Ste 410",
"city": "Jacksonville",
"state": "FL",
"country_code": "US",
"postal_code": "322589486",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 2, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.