Jordan Wade McDougal, RBT

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

1411 Princess Anne Street
Fredericksburg, VA 22401

Phone

(540) 922-1110

NPI assigned

Dec 17, 2018

Sex

Male

Sole proprietor

No

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, last updated by the provider on Dec 17, 2018.

{
    "created_epoch": "1545004800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1545004800000",
    "number": "1669943536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "114 JIB DR",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225545322",
            "telephone_number": "540-699-4922"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1411 PRINCESS ANNE STREET",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "22401",
            "telephone_number": "540-922-1110"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCDOUGAL",
        "first_name": "JORDAN",
        "middle_name": "WADE",
        "name_prefix": "Mr.",
        "credential": "RBT",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2018-12-17",
        "last_updated": "2018-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Brian McDermott, M.D.
• Michael McDermott, M.D.
• Kimberly McDonald, N.P.
• Micah Daniel McDonald, PA-C
• Ryan A McDonnel, DC
• Kenneth Michael McDowell, DO
• Kimberly McFadyen, PTA
• Ashley McGee, NP
• Mary E McGhee, MA, CCMHC, NCC
• Brandon McGiness

• All providers in Fredericksburg, VA
• Behavior Technician in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2018; 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.