Timara Nicole Mickens

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

491 Chapman Rd Lot 111
Fountain Inn, SC 29644-6139

Phone

(843) 408-5798

NPI assigned

Apr 24, 2023

Sex

Female

Sole proprietor

No

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Apr 24, 2023.

{
    "created_epoch": "1682294400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682294400000",
    "number": "1831887397",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "166 SOUTHPORT DR",
            "city": "SUMMERVILLE",
            "state": "SC",
            "postal_code": "294837082",
            "telephone_number": "843-408-5798"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "491 CHAPMAN RD LOT 111",
            "city": "FOUNTAIN INN",
            "state": "SC",
            "postal_code": "296446139",
            "telephone_number": "843-408-5798"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKENS",
        "first_name": "TIMARA",
        "middle_name": "NICOLE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2023-04-24",
        "last_updated": "2023-04-24",
        "certification_date": "2023-04-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Randy L Marg, OT
• Katlyn Marks, DC
• Meredith Marlowe, OTR/L
• Leah M Mauritz, RPH
• Yalianis Mendive, BEHAVIOR ASSISTANT
• Kristen Markham Middlebrooks
• Jessica Brooke Miebach, OTD, OTR/L
• Sandra Lee Miles, P.T.
• Brittney Miller, COTA/L
• Pamela Mitchell, PTA

• All providers in Fountain Inn, SC
• Behavior Technician in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 24, 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.

Verify at the official NPI Registry.