Kelly John Shover

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

1521 Hilton Ave
Fairbanks, AK 99701-4015

Phone

(907) 371-1300

NPI assigned

Apr 11, 2024

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

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

{
    "created_epoch": "1712793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1712793600000",
    "number": "1619720232",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4020 FOLKER ST",
            "city": "ANCHORAGE",
            "state": "AK",
            "postal_code": "995085386",
            "telephone_number": "907-563-1000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1521 HILTON AVE",
            "city": "FAIRBANKS",
            "state": "AK",
            "postal_code": "997014015",
            "telephone_number": "907-371-1300"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHOVER",
        "first_name": "KELLY",
        "middle_name": "JOHN",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2024-04-11",
        "last_updated": "2024-04-11",
        "certification_date": "2024-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shaylee Shocklee
• Nathon Shoemaker
• Abrianna Short
• Crystal Short
• Brian Shoulders, DPT
• Jessika Shumate, BA
• Celine Siddall, R.D.
• Fabienne Rose Marie Siddall
• Sherry Y. Sieben, MT
• Leslie Gene Siegfried

• All providers in Fairbanks, AK
• Behavior Technician in Alaska

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2024; 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.