Active NPI
Kenya Wynn
- Behavior Analyst
- Kernersville, NC
National Provider Identifier
1689165144
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-20-42838
- Practice address
- 418B W Mountain St Ste B
Kernersville, NC 27284-2534 - Phone
- (801) 614-2587
- NPI assigned
- May 21, 2018
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 3
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Analyst | 103K00000X | 1-20-42838 | NC | Primary |
| Behavior Technician | 106S00000X | |||
| Mental Health Counselor | 101YM0800X |
Addresses
Primary practice location
418B W Mountain St Ste B
Kernersville, NC 27284-2534
Mailing address
418 W Mountain St Ste B
Kernersville, NC 27284-2534
Phone (801) 614-2587
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": "1526860800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630454400000",
"number": "1689165144",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "418 W MOUNTAIN ST STE B",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272842534",
"telephone_number": "801-614-2587"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "418B W MOUNTAIN ST STE B",
"city": "KERNERSVILLE",
"state": "NC",
"postal_code": "272842534",
"telephone_number": "801-614-2587"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WYNN",
"first_name": "KENYA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2018-05-21",
"last_updated": "2021-09-01",
"certification_date": "2021-09-01",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NC",
"license": "1-20-42838",
"primary": true
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": false
},
{
"code": "101YM0800X",
"taxonomy_group": "",
"desc": "Counselor, Mental Health",
"state": null,
"license": null,
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kernersville, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 1, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.