Kanisha Nicole Eberhardt, QASP-S

Primary specialty

Assistant Behavior AnalystTaxonomy code 106E00000X

License

11343

Practice address

3633 Wheeler Rd Ste 320
Augusta, GA 30909-6552

Phone

(706) 842-3279

NPI assigned

Jul 7, 2021

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

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.

• Pediatric Autism Clinical & Evaluation Services LLC

  • Clinical Psychologist
  • Augusta, GA
  • NPI 1689198194
  NPD (past)

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

{
    "created_epoch": "1625616000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1699315200000",
    "number": "1548831902",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3633 WHEELER RD STE 320",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309096552",
            "telephone_number": "706-842-3279"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3633 WHEELER RD STE 320",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309096552",
            "telephone_number": "706-842-3279"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EBERHARDT",
        "first_name": "KANISHA",
        "middle_name": "NICOLE",
        "name_prefix": "Ms.",
        "credential": "QASP-S",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2021-07-07",
        "last_updated": "2023-11-07",
        "certification_date": "2023-11-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "",
            "desc": "Technician, Other",
            "state": "GA",
            "license": "RBT-20-119073",
            "primary": false
        },
        {
            "code": "106E00000X",
            "taxonomy_group": "",
            "desc": "Assistant Behavior Analyst",
            "state": null,
            "license": "11343",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• East Central Public Health District
• East Georgia Internal Medicine ,LLC
• Kenneth Scott Easters, DO
• Blake Eaton, DDS
• Joanne Eaves
• Chelsea R Eberhart
• Frank Andrew Eberheart, PA-C
• Matthew Daniel Eberly Sr., MD
• Sherri J. Ebetino, PTA
• Marian T Ebron, M.D.

• Assistant Behavior Analyst in Augusta, GA
• Providers in Augusta, GA by specialty
• Assistant Behavior Analyst in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 7, 2023; 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.