Active NPI
Jacquelyn Mikelson
- Behavior Technician
- Kailua Kona, HI
National Provider Identifier
1790487338
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- BACB851600
- Practice address
- 75-5591 Palani Rd Ste 204
Kailua Kona, HI 96740-3632 - Phone
- (808) 345-6653
- NPI assigned
- Mar 20, 2023
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | BACB851600 | HI | Primary |
Addresses
Primary practice location
75-5591 Palani Rd Ste 204
Kailua Kona, HI 96740-3632
Mailing address
74-5050 Hanahanai Loop
Kailua Kona, HI 96740-1537
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 |
|---|---|---|---|
| BACB851600 | HI | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679270400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1679270400000",
"number": "1790487338",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "74-5050 HANAHANAI LOOP",
"city": "KAILUA KONA",
"state": "HI",
"postal_code": "967401537"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "75-5591 PALANI RD STE 204",
"city": "KAILUA KONA",
"state": "HI",
"postal_code": "967403632",
"telephone_number": "808-345-6653"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MIKELSON",
"first_name": "JACQUELYN",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2023-03-20",
"last_updated": "2023-03-20",
"certification_date": "2023-03-19",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "HI",
"license": "BACB851600",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Kailua Kona, HI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 20, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.