John Andrew Fowler
Individual provider Active NPI Behavior Analyst · Las Vegas, NV
NPI 1689013757 · NPPES record last updated Jun 21, 2013
Key facts
- NPI
- 1689013757
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Behavior Analyst 103K00000X
- Practice address
- 1878 Trilly LN
Las Vegas, NV 89156-6877 - Phone
- (702) 824-3981
- NPI assigned
- Jun 21, 2013
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | NV | Yes |
Addresses
Primary practice location
1878 Trilly LN
Las Vegas, NV 89156-6877
Mailing address
1878 Trilly LN
Las Vegas, NV 89156-6877
Phone (702) 824-3981
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 225400000X | Medicaid | NV |
Other providers in Las Vegas, NV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Jun 21, 2013. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.