Active NPI
Chriesty Jordan
- Behavior Technician
- Palm City, FL
National Provider Identifier
1760231906
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-24-357379
- Practice address
- 1532 SW Mapp Rd
Palm City, FL 34990-2446 - Phone
- (772) 678-6704
- NPI assigned
- May 17, 2024
- Last updated
- Nov 26, 2024
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Assistant Behavior Analyst | 106E00000X | |||
| Behavior Technician | 106S00000X | RBT-24-357379 | FL | Primary |
Addresses
Primary practice location
1532 SW Mapp Rd
Palm City, FL 34990-2446
Mailing address
1532 SW Mapp Rd
Palm City, FL 34990-2446
Phone (772) 678-6704
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 123122300 | Medicaid | FL |
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 |
|---|---|---|---|
| RBT-24-357379 | FL | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1715904000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1732579200000",
"number": "1760231906",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1532 SW MAPP RD",
"city": "PALM CITY",
"state": "FL",
"postal_code": "349902446",
"telephone_number": "772-678-6704"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1532 SW MAPP RD",
"city": "PALM CITY",
"state": "FL",
"postal_code": "349902446",
"telephone_number": "772-678-6704"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JORDAN",
"first_name": "CHRIESTY",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2024-05-17",
"last_updated": "2024-11-26",
"certification_date": "2024-11-26",
"status": "A"
},
"taxonomies": [
{
"code": "106E00000X",
"taxonomy_group": "",
"desc": "Assistant Behavior Analyst",
"state": null,
"license": null,
"primary": false
},
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "FL",
"license": "RBT-24-357379",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "123122300",
"state": "FL"
}
],
"endpoints": [],
"other_names": []
}Other providers in Palm City, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 26, 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.