Active NPI
Angela Jefferson, LPN
- Behavior Analyst
- Clinton, MO
National Provider Identifier
1659771640
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 2012000882
- Practice address
- 505 S 11TH Street Ter
Clinton, MO 64735-2319 - Phone
- (660) 924-6189
- NPI assigned
- Aug 27, 2014
- 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 | 2012000882 | MO | Primary |
Addresses
Primary practice location
505 S 11TH Street Ter
Clinton, MO 64735-2319
Mailing address
505 S 11TH Street Ter
Clinton, MO 64735-2319
Phone (660) 924-6189
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
| License | State | Type | Specialty |
|---|---|---|---|
| 2012000882 | MO | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1409097600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1409097600000",
"number": "1659771640",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "505 S 11TH STREET TER",
"city": "CLINTON",
"state": "MO",
"postal_code": "647352319",
"telephone_number": "660-924-6189"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "505 S 11TH STREET TER",
"city": "CLINTON",
"state": "MO",
"postal_code": "647352319",
"telephone_number": "660-924-6189"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JEFFERSON",
"first_name": "ANGELA",
"credential": "LPN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2014-08-27",
"last_updated": "2014-08-27",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "MO",
"license": "2012000882",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Clinton, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 27, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.