Active NPI
Mary Melissa Phipps
- Behavior Technician
- Kokomo, IN
National Provider Identifier
1417654807
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 2900 S Dixon St
Kokomo, IN 46901-3268 - Phone
- (317) 270-0584
- NPI assigned
- Feb 15, 2023
- Last updated
- Feb 15, 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 | IN | Primary |
Addresses
Primary practice location
2900 S Dixon St
Kokomo, IN 46901-3268
Mailing address
2900 S Dixon St
Kokomo, IN 46901-3268
Phone (317) 270-0584
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RBT-22-207546 | Other | IN | BEHAVIOR ANALYST CERTIFICATION BOARD |
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": "1676419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676419200000",
"number": "1417654807",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2900 S DIXON ST",
"city": "KOKOMO",
"state": "IN",
"postal_code": "469013268",
"telephone_number": "317-270-0584"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2900 S DIXON ST",
"city": "KOKOMO",
"state": "IN",
"postal_code": "469013268",
"telephone_number": "317-270-0584"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PHIPPS",
"first_name": "MARY",
"middle_name": "MELISSA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-15",
"last_updated": "2023-02-15",
"certification_date": "2023-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "IN",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEHAVIOR ANALYST CERTIFICATION BOARD",
"identifier": "RBT-22-207546",
"state": "IN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Kokomo, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 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.