Active NPI
Krisha Agatep
- Behavior Analyst
- Jacksonville, FL
National Provider Identifier
1629638804
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-18-34361
- Practice address
- 2805 Wycombe Dr W
Jacksonville, FL 32277-3766 - Phone
- (904) 802-4972
- NPI assigned
- Jun 19, 2019
- 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 Analyst | 103K00000X | 1-18-34361 | Primary |
Addresses
Primary practice location
2805 Wycombe Dr W
Jacksonville, FL 32277-3766
Mailing address
2805 Wycombe Dr W
Jacksonville, FL 32277-3766
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1560902400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1560902400000",
"number": "1629638804",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2805 WYCOMBE DR W",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322773766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2805 WYCOMBE DR W",
"city": "JACKSONVILLE",
"state": "FL",
"postal_code": "322773766",
"telephone_number": "904-802-4972"
}
],
"practiceLocations": [],
"basic": {
"last_name": "AGATEP",
"first_name": "KRISHA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-06-19",
"last_updated": "2019-06-19",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "193400000X SINGLE SPECIALTY GROUP",
"desc": "Behavior Analyst",
"state": null,
"license": "1-18-34361",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jacksonville, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 19, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.