Andrea Niccole Kornelis

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-20-44631

Practice address

400 18TH Ave SE Apt 55
Minot, ND 58701-6613

Phone

(707) 450-7587

NPI assigned

May 7, 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 identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

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

• Total Behavior Support LLC

  • Behavior Analyst
  • Minot, ND
  • NPI 1518541713
  NPD Authorized official

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

{
    "created_epoch": "1525651200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1621555200000",
    "number": "1740779644",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "400 18TH AVE SE APT 55",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587016613",
            "telephone_number": "707-450-7587"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "400 18TH AVE SE APT 55",
            "city": "MINOT",
            "state": "ND",
            "postal_code": "587016613",
            "telephone_number": "707-450-7587"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KORNELIS",
        "first_name": "ANDREA",
        "middle_name": "NICCOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-07",
        "last_updated": "2021-05-21",
        "certification_date": "2021-05-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": "1-20-44631",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BEHAVIORAL HEALTH",
            "identifier": "106S00000X",
            "state": "CO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Scott E Knutson, MD
• Erin Koehmstedt, AU.D.
• Haley Kay Kohler, LMSW
• Sina Koochakzadeh
• Emily Kopp, RDN
• Allison Kosanda
• Jenna B Kourajian, RD, LRD
• Kelsey Kozel
• Alyssa Leigh Kraft, LMT
• Andrea H Kraft

• All providers in Minot, ND
• Behavior Analyst in North Dakota

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 21, 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.

Verify at the official NPI Registry.