Active NPI
Jennifer Deberard
- Behavior Technician
- Laramie, WY
National Provider Identifier
1831838218
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 1050 N 3Rd St Ste I
Laramie, WY 82072-2543 - Phone
- (307) 212-3284
- NPI assigned
- Jun 2, 2022
- Last updated
- May 11, 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 | NU | Primary |
Addresses
Primary practice location
1050 N 3Rd St Ste I
Laramie, WY 82072-2543
Mailing address
PO Box 20310
Unit 55984
Cheyenne, WY 82003-7007
Phone (307) 212-3284
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| Other URL | www.pkservice.org |
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Jackson Hole Behavioral Services, LLC | Current | Accepting new patients |
Locations
1050 N 3rd St
Ste I
Laramie, WY 82072
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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.
-
dba Peak Behavioral Services, LLC
- Early Intervention Provider Agency
- Laramie, WY
- NPI 1881071355
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1654128000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1683763200000",
"number": "1831838218",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 20310",
"address_2": "UNIT 55984",
"city": "CHEYENNE",
"state": "WY",
"postal_code": "820037007",
"telephone_number": "307-212-3284"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 N 3RD ST STE I",
"city": "LARAMIE",
"state": "WY",
"postal_code": "820722543",
"telephone_number": "307-212-3284"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEBERARD",
"first_name": "JENNIFER",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2022-06-02",
"last_updated": "2023-05-11",
"certification_date": "2023-05-01",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "NU",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "OTHERS",
"endpointTypeDescription": "Other URL",
"endpoint": "www.pkservice.org",
"affiliation": "N",
"address_1": "310 E Broadway Ave",
"city": "Jackson",
"state": "WY",
"country_code": "US",
"postal_code": "830018636",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Laramie, WY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 11, 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.