Kendall Logan Nebeker

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

4943 N 29TH E # B
Idaho Falls, ID 83401-1314

Phone

(307) 257-5487

NPI assigned

Apr 26, 2022

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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.

• Jackson Hole Behavioral Services, LLC

  • Early Intervention Provider Agency
  • Laramie, WY
  • NPI 1881071355
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1650931200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1704326400000",
    "number": "1477297265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 20310",
            "address_2": "PMB 55984",
            "city": "CHEYENNE",
            "state": "WY",
            "postal_code": "820031970"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4943 N 29TH E # B",
            "city": "IDAHO FALLS",
            "state": "ID",
            "postal_code": "834011314",
            "telephone_number": "307-257-5487"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NEBEKER",
        "first_name": "KENDALL",
        "middle_name": "LOGAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2022-04-26",
        "last_updated": "2024-01-04",
        "certification_date": "2024-01-04",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1396085718",
            "state": "UT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Noor Ashraf Nassef, DO
• Richard Alan Nathan, D.O.
• Jerry Blair Nave, OD
• Monica J Nealis, PA-C
• Jace Nebeker, DNP, APRN,FNP-C
• Kierstin Nebeker, DNP
• James P Neeley, MD
• David Neff, LSW
• Shanna Neff, MSN, PMHNP-BC
• Neider Counseling PA

• Behavior Technician in Idaho Falls, ID
• Providers in Idaho Falls, ID by specialty
• Behavior Technician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.