Active NPI
Jennifer E Humphreys, MS, MED, BCBA
- Behavior Analyst
- Fuquay Varina, NC
National Provider Identifier
1790288371
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Analyst
- License
- 1-18-31808
- Practice address
- 4929 Darcy Woods LN
Fuquay Varina, NC 27526-7622 - Phone
- (408) 540-4551
- NPI assigned
- Mar 9, 2018
- Last updated
- Oct 27, 2020
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Student in an Organized Health Care Education/Training Program | 390200000X | NU | ||
| Behavior Analyst | 103K00000X | 1-18-31808 | NU | Primary |
Addresses
Primary practice location
4929 Darcy Woods LN
Fuquay Varina, NC 27526-7622
Mailing address
510 Ridgecrest Rd
Cary, NC 27511-3119
Phone (408) 540-4551
Other practice location 1
1500 E Hamilton Ave Ste 105
Campbell, CA 95008-0834
Phone (408) 540-4551
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
- Credentials
- Master of Education, Master of Science
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Little Green Thumbs ABA LLC | Current | Accepting new patients | |
| Advanced ABA Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
- Community/Behavioral Health Agency
- Demotte, IN
- NPI 1659031797
-
- Early Intervention Provider Agency
- Campbell, CA
- NPI 1174863518
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1520553600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1603756800000",
"number": "1790288371",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 RIDGECREST RD",
"city": "CARY",
"state": "NC",
"postal_code": "275113119",
"telephone_number": "408-540-4551"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4929 DARCY WOODS LN",
"city": "FUQUAY VARINA",
"state": "NC",
"postal_code": "275267622",
"telephone_number": "408-540-4551"
}
],
"practiceLocations": [
{
"address_1": "1500 E Hamilton Ave Ste 105",
"address_purpose": "LOCATION",
"city": "Campbell",
"state": "CA",
"postal_code": "950080834",
"country_code": "US",
"telephone_number": "408-540-4551",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HUMPHREYS",
"first_name": "JENNIFER",
"middle_name": "E",
"credential": "MS, MED, BCBA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2018-03-09",
"last_updated": "2020-10-27",
"certification_date": "2020-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "390200000X",
"taxonomy_group": "",
"desc": "Student in an Organized Health Care Education/Training Program",
"state": "NU",
"license": null,
"primary": false
},
{
"code": "103K00000X",
"taxonomy_group": "",
"desc": "Behavior Analyst",
"state": "NU",
"license": "1-18-31808",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Fuquay Varina, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 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.