Tyler Rowberry Moulton, BSBI

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

Practice address

420 Cardinal Dr
Shelley, ID 83274-4925

Phone

(208) 360-4210

NPI assigned

Jun 1, 2020

Last updated

Jun 1, 2020By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Other identifiers 1

Electronic endpoints 1

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.

{
    "created_epoch": "1590969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1590969600000",
    "number": "1861016339",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "420 CARDINAL DR",
            "city": "SHELLEY",
            "state": "ID",
            "postal_code": "832744925",
            "telephone_number": "208-360-4210"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "420 CARDINAL DR",
            "city": "SHELLEY",
            "state": "ID",
            "postal_code": "832744925",
            "telephone_number": "208-360-4210"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MOULTON",
        "first_name": "TYLER",
        "middle_name": "ROWBERRY",
        "name_prefix": "Mrs.",
        "credential": "BSBI",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2020-06-01",
        "last_updated": "2020-06-01",
        "certification_date": "2020-06-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "ID",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6169",
            "state": "ID"
        }
    ],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "URL",
            "affiliation": "N",
            "address_1": "420 Cardinal Dr",
            "city": "Shelley",
            "state": "ID",
            "country_code": "US",
            "postal_code": "832744925",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Viktoriya Lichtenberg
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• Mbknowles Behavior & Mental Health Therapy
• Danielle Hutchings McKinney
• Craig Moulton
• MVH BMC LLC (Shelley Family Medical Center)
• Deidra Nichols, DPT
• Steven F Nielsen, D.D.S.
• Nippert Chiropractic Health Center, P.a.
• Aaron Walter Nippert, D.C.

• Behavior Technician in Shelley, ID
• Providers in Shelley, ID by specialty
• Behavior Technician in Idaho

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 1, 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.

Verify at the official NPI Registry.