Active NPI
Mkenna Catheryn Mosby
- Behavior Technician
- Rohnert Park, CA
National Provider Identifier
1699355628
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 2 Padre Pkwy Ste 101
Rohnert Park, CA 94928-2114 - Phone
- (707) 553-1784
- NPI assigned
- Apr 13, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | Primary |
Addresses
Primary practice location
2 Padre Pkwy Ste 101
Rohnert Park, CA 94928-2114
Mailing address
100 Main St. PO Box 68
San Quentin, CA 94964-0068
Phone (415) 747-5838
Other practice location 1
100 Main St.
San Quentin, CA 94964-0068
Phone (415) 747-5838
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": "1618272000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1618272000000",
"number": "1699355628",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "100 MAIN ST. PO BOX 68",
"city": "SAN QUENTIN",
"state": "CA",
"postal_code": "949640068",
"telephone_number": "415-747-5838"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 PADRE PKWY STE 101",
"city": "ROHNERT PARK",
"state": "CA",
"postal_code": "949282114",
"telephone_number": "707-553-1784"
}
],
"practiceLocations": [
{
"address_1": "100 Main St.",
"address_purpose": "LOCATION",
"city": "San Quentin",
"state": "CA",
"postal_code": "949640068",
"country_code": "US",
"telephone_number": "415-747-5838",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "MOSBY",
"first_name": "MKENNA",
"middle_name": "CATHERYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2021-04-13",
"last_updated": "2021-04-13",
"certification_date": "2021-03-17",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Rohnert Park, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 13, 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.