Active NPI
Tyler Michelle Waggoner
- Behavior Technician
- Virginia Beach, VA
National Provider Identifier
1831600253
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 780 Lynnhaven Pkwy Ste 400
Virginia Beach, VA 23452-7332 - Phone
- (888) 880-9270
- NPI assigned
- Oct 12, 2017
- 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 | Primary |
Addresses
Primary practice location
780 Lynnhaven Pkwy Ste 400
Virginia Beach, VA 23452-7332
Mailing address
3609 Wetherington Dr Apt 102
Virginia Beach, VA 23453-1888
Phone (757) 510-7235
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": "1507766400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1507766400000",
"number": "1831600253",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "3609 WETHERINGTON DR APT 102",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234531888",
"telephone_number": "757-510-7235"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "780 LYNNHAVEN PKWY STE 400",
"city": "VIRGINIA BEACH",
"state": "VA",
"postal_code": "234527332",
"telephone_number": "888-880-9270"
}
],
"practiceLocations": [],
"basic": {
"last_name": "WAGGONER",
"first_name": "TYLER",
"middle_name": "MICHELLE",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2017-10-12",
"last_updated": "2017-10-12",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Virginia Beach, VA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 12, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.