Active NPI
Kellsea Agnes Lee Clyde
- Behavior Analyst
- San Bruno, CA
National Provider Identifier
1699472076
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- Practice address
- 23 Pacific Bay Cir Apt 106
San Bruno, CA 94066-6140 - Phone
- (415) 310-6495
- NPI assigned
- Feb 15, 2023
- Sex
- Female
- Sole proprietor
- No
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 Analyst | 103K00000X | CA | Primary |
Addresses
Primary practice location
23 Pacific Bay Cir Apt 106
San Bruno, CA 94066-6140
Mailing address
7108 S Kanner Hwy
Stuart, FL 34997-7462
Phone (772) 349-6317
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": "1676419200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1676419200000",
"number": "1699472076",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7108 S KANNER HWY",
"city": "STUART",
"state": "FL",
"postal_code": "349977462",
"telephone_number": "772-349-6317"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "23 PACIFIC BAY CIR APT 106",
"city": "SAN BRUNO",
"state": "CA",
"postal_code": "940666140",
"telephone_number": "415-310-6495"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLYDE",
"first_name": "KELLSEA",
"middle_name": "AGNES LEE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-02-15",
"last_updated": "2023-02-15",
"certification_date": "2023-02-15",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "CA",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Bruno, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.