Active NPI
Lynette Medley
- Behavior Technician
- Ozark, AL
National Provider Identifier
1356087993
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 21-193378
- Practice address
- 1880 S Union Ave C, Ozark, Al 36360
Ozark, AL 36360 - Phone
- (334) 443-1043
- NPI assigned
- May 6, 2022
- 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 | 21-193378 | AL | Primary |
Addresses
Primary practice location
1880 S Union Ave C, Ozark, Al 36360
Ozark, AL 36360
Mailing address
815 E Lee St Apt 7B
Enterprise, AL 36330-2034
Phone (133) 444-9132
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5300012300198 | Medicaid | AL |
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 |
|---|---|---|---|
| 21-193378 | AL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1651795200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1651795200000",
"number": "1356087993",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "815 E LEE ST APT 7B",
"city": "ENTERPRISE",
"state": "AL",
"postal_code": "363302034",
"telephone_number": "133-444-9132"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1880 S UNION AVE C, OZARK, AL 36360",
"city": "OZARK",
"state": "AL",
"postal_code": "36360",
"telephone_number": "334-443-1043"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MEDLEY",
"first_name": "LYNETTE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2022-05-06",
"last_updated": "2022-05-06",
"certification_date": "2022-04-22",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "AL",
"license": "21-193378",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "5300012300198",
"state": "AL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Ozark, AL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 6, 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.