Active NPI
Isabella Manuel
- Behavior Technician
- Ridgeland, MS
National Provider Identifier
1497564223
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 802905597
- Practice address
- 402 Legacy Park
Ridgeland, MS 39157-4315 - Phone
- (769) 233-7154
- NPI assigned
- Jan 6, 2025
- 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 Technician | 106S00000X | 802905597 | MS | Primary |
Addresses
Primary practice location
402 Legacy Park
Ridgeland, MS 39157-4315
Mailing address
110 Waterwood Dr
Brandon, MS 39047-6527
Phone (601) 910-1415
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 |
|---|---|---|---|
| 802905597 | MS | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1736121600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1736121600000",
"number": "1497564223",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "110 WATERWOOD DR",
"city": "BRANDON",
"state": "MS",
"postal_code": "390476527",
"telephone_number": "601-910-1415"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "402 LEGACY PARK",
"city": "RIDGELAND",
"state": "MS",
"postal_code": "391574315",
"telephone_number": "769-233-7154"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MANUEL",
"first_name": "ISABELLA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2025-01-06",
"last_updated": "2025-01-06",
"certification_date": "2025-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MS",
"license": "802905597",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Ridgeland, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.