Kayla Diane Wagner, M.S., BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-19-35267

Practice address

902 W Main St
West Frankfort, IL 62896

Phone

(855) 608-3560

NPI assigned

Oct 4, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kayla Diane Brachbill Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

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

{
    "created_epoch": "1538611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1564012800000",
    "number": "1730654922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "902 W MAIN ST",
            "city": "WEST FRANKFORT",
            "state": "IL",
            "postal_code": "628962210",
            "telephone_number": "618-937-6483"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "902 W MAIN ST",
            "city": "WEST FRANKFORT",
            "state": "IL",
            "postal_code": "62896",
            "telephone_number": "855-608-3560"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "902 W Main St",
            "address_purpose": "LOCATION",
            "city": "West Frankfort",
            "state": "IL",
            "postal_code": "62896",
            "country_code": "US",
            "telephone_number": "855-608-3560 x7623",
            "country_name": "United States",
            "address_type": "DOM"
        },
        {
            "address_1": "402 E Plaza Dr Ste 5",
            "address_purpose": "LOCATION",
            "city": "Carterville",
            "state": "IL",
            "postal_code": "629182092",
            "country_code": "US",
            "telephone_number": "618-319-6060",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "WAGNER",
        "first_name": "KAYLA",
        "middle_name": "DIANE",
        "credential": "M.S., BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-10-04",
        "last_updated": "2019-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-19-35267",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAYLA",
            "last_name": "BRACHBILL",
            "middle_name": "DIANE",
            "credential": "M.S., BCBA",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Behavior Analyst in West Frankfort, IL
• Providers in West Frankfort, IL by specialty
• Behavior Analyst in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 25, 2019; 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.