Active NPI
Jessica P Green
- Behavior Analyst
- Mesa, AZ
National Provider Identifier
1417108218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 10932
- Practice address
- 1659 E Draper Cir
Mesa, AZ 85203-6628 - Phone
- (480) 892-8071
- NPI assigned
- Oct 10, 2008
- Last updated
- Oct 10, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 Analyst | 103K00000X | 10932 | AZ | Primary |
Addresses
Primary practice location
1659 E Draper Cir
Mesa, AZ 85203-6628
Mailing address
1659 E Draper Cir
Mesa, AZ 85203-6628
Phone (480) 892-8071
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 |
|---|---|---|---|
| 10932 | AZ | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1223596800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1223596800000",
"number": "1417108218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1659 E DRAPER CIR",
"city": "MESA",
"state": "AZ",
"postal_code": "852036628",
"telephone_number": "480-892-8071"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1659 E DRAPER CIR",
"city": "MESA",
"state": "AZ",
"postal_code": "852036628",
"telephone_number": "480-892-8071"
}
],
"practiceLocations": [],
"basic": {
"last_name": "GREEN",
"first_name": "JESSICA",
"middle_name": "P",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-10-10",
"last_updated": "2008-10-10",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "AZ",
"license": "10932",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Mesa, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 10, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.