Active NPI
Moise Vidro, RBT
- Behavior Technician
- Hopkinsville, KY
National Provider Identifier
1801569876
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-21-175735
- Practice address
- 2707 Florence Dr
Hopkinsville, KY 42240-1637 - Phone
- (803) 201-0792
- NPI assigned
- Jul 27, 2021
- Sex
- Male
- 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 | RBT-21-175735 | TN | Primary |
Addresses
Primary practice location
2707 Florence Dr
Hopkinsville, KY 42240-1637
Mailing address
2707 Florence Dr
Hopkinsville, KY 42240-1637
Phone (803) 201-0792
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| RBT-21-175735 | Other | TN | BEHAVIOR TECHNICIAN |
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-21-175735 | TN | MD | Behavior Technician |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Advanced Behavior Consultants | Behavior Technician | Past | Accepting new patients |
Organizations & group practices 1
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.
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1627344000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1694563200000",
"number": "1801569876",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2707 FLORENCE DR",
"city": "HOPKINSVILLE",
"state": "KY",
"postal_code": "422401637",
"telephone_number": "803-201-0792"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2707 FLORENCE DR",
"city": "HOPKINSVILLE",
"state": "KY",
"postal_code": "422401637",
"telephone_number": "803-201-0792"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VIDRO",
"first_name": "MOISE",
"credential": "RBT",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2021-07-27",
"last_updated": "2023-09-13",
"certification_date": "2023-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "TN",
"license": "RBT-21-175735",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BEHAVIOR TECHNICIAN",
"identifier": "RBT-21-175735",
"state": "TN"
}
],
"endpoints": [],
"other_names": []
}Other providers in Hopkinsville, KY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 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.