Active NPI
Raphael Bonelle
- Behavior Analyst
- Oklahoma City, OK
National Provider Identifier
1548613425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 308629
- Practice address
- 12000 N Virginia Ave
Oklahoma City, OK 73120-7581 - Phone
- (405) 835-6757
- NPI assigned
- Jul 15, 2016
- Sex
- Male
- 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 Analyst | 103K00000X | 308629 | OK | Primary |
Addresses
Primary practice location
12000 N Virginia Ave
Oklahoma City, OK 73120-7581
Mailing address
5924 SW 12TH St
Apt 5304
Oklahoma City, OK 73128-5900
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 |
|---|---|---|---|
| 308629 | OK | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1468540800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1468540800000",
"number": "1548613425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5924 SW 12TH ST",
"address_2": "APT 5304",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731285900"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12000 N VIRGINIA AVE",
"city": "OKLAHOMA CITY",
"state": "OK",
"postal_code": "731207581",
"telephone_number": "405-835-6757"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BONELLE",
"first_name": "RAPHAEL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2016-07-15",
"last_updated": "2016-07-15",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "OK",
"license": "308629",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Oklahoma City, OK
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 15, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.