Active NPI
Nisha Diann Mallory, RBT
- Behavior Analyst
- Jacksonville, FL
National Provider Identifier
1467071332
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 103K00000
- Practice address
- 6820 Southpoint Pkwy Ste 9
Jacksonville, FL 32216-6277 - Phone
- (888) 754-0398
- NPI assigned
- Apr 10, 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 103K00000 | Primary |
Addresses
Primary practice location
6820 Southpoint Pkwy Ste 9
Jacksonville, FL 32216-6277
Mailing address
1710 Wells Rd Apt 312
Orange Park, FL 32073-2376
Phone (912) 657-9489
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": "1586476800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1586476800000",
"number": "1467071332",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1710 WELLS RD APT 312",
"city": "ORANGE PARK",
"state": "FL",
"postal_code": "320732376",
"telephone_number": "912-657-9489"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "6820 SOUTHPOINT PKWY STE 9",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322166277",
"telephone_number": "888-754-0398"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MALLORY",
"first_name": "NISHA",
"middle_name": "DIANN",
"credential": "RBT",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2020-04-10",
"last_updated": "2020-04-10",
"certification_date": "2020-04-10",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": null,
"license": "103K00000",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 10, 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.