Kaylee Rae Porter-Stover

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

3245 Keewahdin Rd
Fort Gratiot, MI 48059-3498

Phone

(810) 937-2345

NPI assigned

Jul 17, 2020

Last updated

Jul 17, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Autism Systems LLC

  • Behavior Analyst
  • Fort Gratiot, MI
  • NPI 1972030724
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1594944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1594944000000",
    "number": "1689282428",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1817 RICHMAN RD",
            "city": "KIMBALL",
            "state": "MI",
            "postal_code": "480742216",
            "telephone_number": "810-824-8487"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3245 KEEWAHDIN RD",
            "city": "FORT GRATIOT",
            "state": "MI",
            "postal_code": "480593498",
            "telephone_number": "810-937-2345"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "9001 Miller Rd Ste 5",
            "address_purpose": "LOCATION",
            "city": "Swartz Creek",
            "state": "MI",
            "postal_code": "484731115",
            "country_code": "US",
            "telephone_number": "248-228-0502",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PORTER-STOVER",
        "first_name": "KAYLEE",
        "middle_name": "RAE",
        "name_prefix": "Mrs.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-07-17",
        "last_updated": "2020-07-17",
        "certification_date": "2020-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Port Huron Mercy Family Care Inc
• Port Huron Neurologic Associates P.C.
• Port Huron Opco LLC (Medilodge of Port Huron)
• Port Huron Physicians Medical Group PC (Lake Huron Medical Group)
• Port Huron Physicians Medical Group PC
• Skylar Kathleen Potter
• Rebecca Ann Powelson
• Rajat Prakash, M.D.
• Kimberly A Prevost
• Prime Garden City Medical Group

• Behavior Technician in Fort Gratiot, MI
• Providers in Fort Gratiot, MI by specialty
• Behavior Technician in Michigan

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