Active NPI
Kennedy Grace Wilson
- Assistant Behavior Analyst
- Charlotte, NC
National Provider Identifier
1639987027
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Assistant Behavior Analyst
- Practice address
- 525 N Tryon St
Charlotte, NC 28202-0202 - Phone
- (855) 832-6727
- NPI assigned
- Dec 18, 2024
- Sex
- Female
- Sole proprietor
- No
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 |
|---|---|---|---|---|
| Assistant Behavior Analyst | 106E00000X | Primary |
Addresses
Primary practice location
525 N Tryon St
Charlotte, NC 28202-0202
Mailing address
4710 Topsail LN Apt 206
Winston Salem, NC 27107-7204
Phone (336) 817-7049
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": "1734480000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1734480000000",
"number": "1639987027",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4710 TOPSAIL LN APT 206",
"city": "WINSTON SALEM",
"state": "NC",
"postal_code": "271077204",
"telephone_number": "336-817-7049"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "525 N TRYON ST",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282020202",
"telephone_number": "855-832-6727"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILSON",
"first_name": "KENNEDY",
"middle_name": "GRACE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-12-18",
"last_updated": "2024-12-18",
"certification_date": "2024-12-18",
"status": "A"
},
"taxonomies": [
{
"code": "106E00000X",
"taxonomy_group": "",
"desc": "Assistant Behavior Analyst",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 18, 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.