Active NPI
Jordyn Kris Wohlgefahrt
- Behavior Technician
- Gulfport, MS
National Provider Identifier
1821613969
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-20-121919
- Practice address
- 9230 Old Lorraine Rd
Gulfport, MS 39503-6059 - Phone
- (228) 731-3500
- NPI assigned
- Jun 15, 2020
- Last updated
- Jun 15, 2020
- 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 | RBT-20-121919 | MS | Primary |
Addresses
Primary practice location
9230 Old Lorraine Rd
Gulfport, MS 39503-6059
Mailing address
12464 Pinehurst CT
Gulfport, MS 39503-7678
Phone (414) 242-8342
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-20-121919 | MS | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1592179200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1592179200000",
"number": "1821613969",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12464 PINEHURST CT",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395037678",
"telephone_number": "414-242-8342"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "9230 OLD LORRAINE RD",
"city": "GULFPORT",
"state": "MS",
"postal_code": "395036059",
"telephone_number": "228-731-3500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WOHLGEFAHRT",
"first_name": "JORDYN",
"middle_name": "KRIS",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2020-06-15",
"last_updated": "2020-06-15",
"certification_date": "2020-06-15",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "MS",
"license": "RBT-20-121919",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Gulfport, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 15, 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.