Individual provider Active NPI

Angus Brian Evanson

  • Behavior Technician
  • Saint Paul, MN
National Provider Identifier
1568310639
Registry record updated Mar 17, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
License
106S00000X Issued in MN
Practice address
1011 Meadowlands Dr
Saint Paul, MN 55127-2339
Phone
(612) 445-0300
NPI assigned
Mar 17, 2026
Last updated
Mar 17, 2026By the provider in NPPES
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Mar 17, 2026

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X 106S00000X MN Primary

Addresses

Primary practice location

1011 Meadowlands Dr
Saint Paul, MN 55127-2339

Mailing address

611 Summit Ave
Saint Paul, MN 55102-2605
Phone (816) 889-8863

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

LicenseStateTypeSpecialty
106S00000XMNMDBehavior Technician

NPI Registry JSON

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

{
    "created_epoch": "1773705600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1773705600000",
    "number": "1568310639",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "611 SUMMIT AVE",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551022605",
            "telephone_number": "816-889-8863"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1011 MEADOWLANDS DR",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551272339",
            "telephone_number": "612-445-0300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "EVANSON",
        "first_name": "ANGUS",
        "middle_name": "BRIAN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-03-17",
        "last_updated": "2026-03-17",
        "certification_date": "2026-03-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "MN",
            "license": "106S00000X",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 17, 2026; 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.