Abagelle Mullen, RBT

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

1872594 Issued in IN

Practice address

2555 Yeager Rd
W Lafayette, IN 47906-1335

Phone

(317) 249-2242

Fax

(317) 663-1175

NPI assigned

Apr 17, 2020

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 17, 2020.

{
    "created_epoch": "1587081600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1587081600000",
    "number": "1760002984",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "550 CONGRESSIONAL BLVD",
            "city": "CARMEL",
            "state": "IN",
            "postal_code": "460325609",
            "telephone_number": "317-249-2242",
            "fax_number": "317-663-1175"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2555 YEAGER RD",
            "city": "W LAFAYETTE",
            "state": "IN",
            "postal_code": "479061335",
            "telephone_number": "317-249-2242",
            "fax_number": "317-663-1175"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLEN",
        "first_name": "ABAGELLE",
        "credential": "RBT",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-04-17",
        "last_updated": "2020-04-17",
        "certification_date": "2020-04-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "IN",
            "license": "1872594",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "201333850D",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Emily Qualkenbush, RBT

• All providers in W Lafayette, IN
• Behavior Technician in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 17, 2020; 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.