Jodi Bennett-Bradshaw

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

418B W Mountain St
Kernersville, NC 27284-2534

Phone

(704) 780-4271

Fax

(704) 788-2016

NPI assigned

Nov 8, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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": "1604793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1604793600000",
    "number": "1669073359",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3902 PONDFIELD CT",
            "city": "GREENSBORO",
            "state": "NC",
            "postal_code": "274109145",
            "telephone_number": "336-420-0443"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "418B W MOUNTAIN ST",
            "city": "KERNERSVILLE",
            "state": "NC",
            "postal_code": "272842534",
            "telephone_number": "704-780-4271",
            "fax_number": "704-788-2016"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BENNETT-BRADSHAW",
        "first_name": "JODI",
        "name_prefix": "Ms.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-11-08",
        "last_updated": "2020-11-08",
        "certification_date": "2020-11-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "DRIVERS LICENSE",
            "identifier": "11991928",
            "state": "NC"
        }
    ],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "GREENSBORO",
            "affiliation": "N",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "contentType": "CSV",
            "contentTypeDescription": "CSV",
            "address_1": "418B W Mountain St",
            "city": "Kernersville",
            "state": "NC",
            "country_code": "US",
            "postal_code": "272842534",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Behavior Technician in Kernersville, NC
• Providers in Kernersville, NC by specialty
• Behavior Technician in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2020; 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.