Individual provider Active NPI

Kristine Henry, BCBA

  • Behavior Analyst
  • Rancho Cucamonga, CA
National Provider Identifier
1659814218
Registry record updated Nov 29, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1-14-15833 Issued in CA
Practice address
10604 N Trademark Pkwy
Suite 310
Rancho Cucamonga, CA 91730-5938
Phone
(714) 697-5480
NPI assigned
Nov 29, 2016
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 29, 2016

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 1-14-15833 CA Primary

Addresses

Primary practice location

10604 N Trademark Pkwy
Suite 310
Rancho Cucamonga, CA 91730-5938

Mailing address

10604 N Trademark Pkwy
Suite 310
Rancho Cucamonga, CA 91730-5938
Phone (714) 697-5480

Other names 1

  • Kristine Conger Former name

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": "1480377600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1480377600000",
    "number": "1659814218",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10604 N TRADEMARK PKWY",
            "address_2": "SUITE 310",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917305938",
            "telephone_number": "714-697-5480"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10604 N TRADEMARK PKWY",
            "address_2": "SUITE 310",
            "city": "RANCHO CUCAMONGA",
            "state": "CA",
            "postal_code": "917305938",
            "telephone_number": "714-697-5480"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "HENRY",
        "first_name": "KRISTINE",
        "credential": "BCBA",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-11-29",
        "last_updated": "2016-11-29",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "CA",
            "license": "1-14-15833",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINE",
            "last_name": "CONGER",
            "credential": "BCBA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Rancho Cucamonga, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 29, 2016; 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.