Ryan Wilkerson, MA, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-19-38161 Issued in FL

Practice address

1750 Tree Blvd Ste 6
St Augustine, FL 32084-5719

Phone

(904) 206-7024

NPI assigned

Jun 6, 2017

Sex

Male

Sole proprietor

Yes

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

Credentials

Master of Arts

Practice roles

Locations

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.

• Allay Behavioral Therapy, LLC

  • Behavior Analyst
  • Saint Augustine, FL
  • NPI 1134930589
  NPD Authorized official
• Allay Behavioral Therapy, LLC

  • Behavior Analyst
  • St Augustine, FL
  • NPI 1235886466
  NPD Authorized official

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

{
    "created_epoch": "1496707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1667347200000",
    "number": "1497284228",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "70 GYPSUM PL",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320868094",
            "telephone_number": "904-206-7024"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1750 TREE BLVD STE 6",
            "city": "ST AUGUSTINE",
            "state": "FL",
            "postal_code": "320845719",
            "telephone_number": "904-206-7024"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "6859 Belfort Oaks Pl",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322166242",
            "country_code": "US",
            "telephone_number": "847-807-3717",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "6820 Southpoint Pkwy Ste 9",
            "address_purpose": "LOCATION",
            "city": "Jacksonville",
            "state": "FL",
            "postal_code": "322166277",
            "country_code": "US",
            "telephone_number": "888-754-0398",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WILKERSON",
        "first_name": "RYAN",
        "credential": "MA, BCBA",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2017-06-06",
        "last_updated": "2022-11-02",
        "certification_date": "2022-11-02",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "1-19-38161",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "020912700",
            "state": "FL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Behavior Analyst in St Augustine, FL
• Providers in St Augustine, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2022; 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.