Bridget L Nkematabong, BEHAVIOR ANALYST

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-20-41106 Issued in NC

Practice address

22 Kassy LN
Stafford, VA 22556-6577

Phone

(253) 722-9152

NPI assigned

Jun 28, 2018

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 3

Addresses

Other names 1

• NA NA NA Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

State licenses

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.

• Providence Community ABA

  • Behavior Analyst
  • Stafford, VA
  • NPI 1902570443
  NPD Authorized official

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

{
    "created_epoch": "1530144000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705968000000",
    "number": "1770078099",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22 KASSY LN",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225566577",
            "telephone_number": "253-722-9152"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22 KASSY LN",
            "city": "STAFFORD",
            "state": "VA",
            "postal_code": "225566577",
            "telephone_number": "253-722-9152"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NKEMATABONG",
        "first_name": "BRIDGET",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "BEHAVIOR ANALYST",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2018-06-28",
        "last_updated": "2024-01-23",
        "certification_date": "2023-08-31",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Analyst",
            "state": "VA",
            "license": "0133002043",
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NC",
            "license": "1-20-41106",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "NA",
            "last_name": "NA",
            "middle_name": "NA",
            "credential": "NA",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Behavior Analyst in Stafford, VA
• Providers in Stafford, VA by specialty
• Behavior Analyst in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 23, 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.

Verify at the official NPI Registry.