Active NPI
Shelby Kimmel
- Behavior Technician
- Sugarloaf, PA
National Provider Identifier
1801478425
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1 Brookhill SQ S
Sugarloaf, PA 18249-1016 - Phone
- (570) 578-5687
- NPI assigned
- Apr 23, 2021
- 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 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | PA | Primary |
Addresses
Primary practice location
1 Brookhill SQ S
Sugarloaf, PA 18249-1016
Mailing address
830 Walnut St
Freeland, PA 18224-1324
Phone (570) 578-5687
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 5708023099 | Other | PA | MISSION AUTISM CLINICS |
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | https://missionautismclinics.com |
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
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1619136000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1619136000000",
"number": "1801478425",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "830 WALNUT ST",
"city": "FREELAND",
"state": "PA",
"postal_code": "182241324",
"telephone_number": "570-578-5687"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1 BROOKHILL SQ S",
"city": "SUGARLOAF",
"state": "PA",
"postal_code": "182491016",
"telephone_number": "570-578-5687"
}
],
"practiceLocations": [],
"basic": {
"last_name": "KIMMEL",
"first_name": "SHELBY",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-04-23",
"last_updated": "2021-04-23",
"certification_date": "2021-04-21",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "PA",
"license": null,
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "MISSION AUTISM CLINICS",
"identifier": "5708023099",
"state": "PA"
}
],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "https://missionautismclinics.com",
"affiliation": "N",
"address_1": "1 Brookhill Sq S",
"city": "Sugarloaf",
"state": "PA",
"country_code": "US",
"postal_code": "182491016",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Sugarloaf, PA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 23, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.