Active NPI
Jenissa Nichols
- Behavior Analyst
- Orem, UT
National Provider Identifier
1407259005
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-17-27668
- Practice address
- 1140 W 1130 S Suite B
Orem, UT 84058 - Phone
- (801) 935-4171
- NPI assigned
- Sep 27, 2014
- Last updated
- Feb 21, 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 |
|---|---|---|---|---|
| School Social Worker | 1041S0200X | |||
| Behavior Analyst | 103K00000X | 1-17-27668 | UT | Primary |
Addresses
Primary practice location
1140 W 1130 S Suite B
Orem, UT 84058
Mailing address
1812 W 1120 S
Springville, UT 84663-3542
Phone (801) 669-6377
Other practice location 1
1875 S Geneva Rd
Orem, UT 84058-2217
Phone (801) 437-0490
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Utah Autism Academy | 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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Developmentally Disabled Services Day Training Agency
- Midvale, UT
- NPI 1972934537
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1411776000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1582243200000",
"number": "1407259005",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1812 W 1120 S",
"city": "SPRINGVILLE",
"state": "UT",
"postal_code": "846633542",
"telephone_number": "801-669-6377"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1140 W 1130 S SUITE B",
"city": "OREM",
"state": "UT",
"postal_code": "84058",
"telephone_number": "801-935-4171"
}
],
"practiceLocations": [
{
"address_1": "1875 S Geneva Rd",
"address_purpose": "LOCATION",
"city": "Orem",
"state": "UT",
"postal_code": "840582217",
"country_code": "US",
"telephone_number": "801-437-0490",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "NICHOLS",
"first_name": "JENISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2014-09-27",
"last_updated": "2020-02-21",
"certification_date": "2020-02-21",
"status": "A"
},
"taxonomies": [
{
"code": "1041S0200X",
"taxonomy_group": "",
"desc": "Social Worker, School",
"state": null,
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "UT",
"license": "1-17-27668",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Orem, UT
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 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.