Active NPI
Andrea Elizabeth Hale
- Behavior Technician
- Russellville, AR
National Provider Identifier
1669185641
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-22-238562
- Practice address
- 301 N Sidney Ave
Russellville, AR 72801-4383 - Phone
- (479) 890-5494
- Fax
- (479) 498-9665
- NPI assigned
- Jan 4, 2023
- 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 |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | RBT-22-238562 | AR | Primary |
Addresses
Primary practice location
301 N Sidney Ave
Russellville, AR 72801-4383
Mailing address
301 N Sidney Ave
Russellville, AR 72801-4383
Phone (479) 890-5494
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 |
|---|---|---|---|
| RBT-22-238562 | AR | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Kid Success, Inc. | Past | Accepting new patients |
Organizations & group practices 1
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Rehabilitation Clinic/Center
- Conway, AR
- NPI 1609997311
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1672790400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1672790400000",
"number": "1669185641",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 N SIDNEY AVE",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728014383",
"telephone_number": "479-890-5494",
"fax_number": "479-498-9665"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "301 N SIDNEY AVE",
"city": "RUSSELLVILLE",
"state": "AR",
"postal_code": "728014383",
"telephone_number": "479-890-5494",
"fax_number": "479-498-9665"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HALE",
"first_name": "ANDREA",
"middle_name": "ELIZABETH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-01-04",
"last_updated": "2023-01-04",
"certification_date": "2023-01-04",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "AR",
"license": "RBT-22-238562",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Russellville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.