Active NPI
Keona Chantel Clark
- Behavior Technician
- Irving, TX
National Provider Identifier
1851196869
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- RBT-24-374289
- Practice address
- 400 E Royal LN Ste 290
Irving, TX 75039-3602 - Phone
- (469) 249-8410
- NPI assigned
- Feb 14, 2025
- 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 | RBT-24-374289 | TX | Primary |
Addresses
Primary practice location
400 E Royal LN Ste 290
Irving, TX 75039-3602
Mailing address
7108 S Kanner Hwy
Stuart, FL 34997-7462
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-24-374289 | TX | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1739491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1739491200000",
"number": "1851196869",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7108 S KANNER HWY",
"city": "STUART",
"state": "FL",
"postal_code": "349977462"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "400 E ROYAL LN STE 290",
"city": "IRVING",
"state": "TX",
"postal_code": "750393602",
"telephone_number": "469-249-8410"
}
],
"practiceLocations": [],
"basic": {
"last_name": "CLARK",
"first_name": "KEONA",
"middle_name": "CHANTEL",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2025-02-14",
"last_updated": "2025-02-14",
"certification_date": "2025-02-14",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "TX",
"license": "RBT-24-374289",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Irving, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 14, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.