Active NPI
Shayne Willard
- Behavior Analyst
- Bastrop, LA
National Provider Identifier
1740004506
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- L-903
- Practice address
- 2048 E Madison Ave
Bastrop, LA 71220-4035 - Phone
- (318) 379-3214
- NPI assigned
- Nov 8, 2024
- Last updated
- Nov 8, 2024
- 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 | L-903 | LA | Primary |
Addresses
Primary practice location
2048 E Madison Ave
Bastrop, LA 71220-4035
Mailing address
2703 Sterlington Rd Apt 49
Monroe, LA 71203-2565
Phone (716) 427-8411
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
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| L-903 | LA | MD | Behavioral Analyst |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1731024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1731024000000",
"number": "1740004506",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2703 STERLINGTON RD APT 49",
"city": "MONROE",
"state": "LA",
"postal_code": "712032565",
"telephone_number": "716-427-8411"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2048 E MADISON AVE",
"city": "BASTROP",
"state": "LA",
"postal_code": "712204035",
"telephone_number": "318-379-3214"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WILLARD",
"first_name": "SHAYNE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2024-11-08",
"last_updated": "2024-11-08",
"certification_date": "2024-11-08",
"status": "A"
},
"taxonomies": [
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "LA",
"license": "L-903",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Bastrop, LA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 8, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.