Active NPI
Skylar Jackson
- Behavior Technician
- Bossier City, LA
National Provider Identifier
1386424117
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- R-12953
- Practice address
- 4440 Viking Dr
Bossier City, LA 71111-7511 - Phone
- (318) 588-8909
- Fax
- (318) 588-8909
- NPI assigned
- Sep 29, 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 | R-12953 | LA | Primary |
Addresses
Primary practice location
4440 Viking Dr
Bossier City, LA 71111-7511
Mailing address
PO Box 1823
West Monroe, LA 71294-1823
Phone (318) 588-8908
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RBT-23-276057 | Other | BACB |
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 |
|---|---|---|---|
| R-12953 | LA | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Behavior Train | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Behavior Analyst
- West Monroe, LA
- NPI 1528437050
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1695945600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1695945600000",
"number": "1386424117",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 1823",
"city": "WEST MONROE",
"state": "LA",
"postal_code": "712941823",
"telephone_number": "318-588-8908",
"fax_number": "318-588-8909"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4440 VIKING DR",
"city": "BOSSIER CITY",
"state": "LA",
"postal_code": "711117511",
"telephone_number": "318-588-8909",
"fax_number": "318-588-8909"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JACKSON",
"first_name": "SKYLAR",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-09-29",
"last_updated": "2023-09-29",
"certification_date": "2023-09-29",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "LA",
"license": "R-12953",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BACB",
"identifier": "RBT-23-276057",
"state": null
}
],
"endpoints": [],
"other_names": []
}Other providers in Bossier City, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 29, 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.