Kelly Phillips, BCBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

1-18-31563 Issued in IN

Practice address

3030 Lake Ave Ste 20
Fort Wayne, IN 46805-5428

Phone

(260) 420-9332

Fax

(866) 446-0198

NPI assigned

May 29, 2018

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Kelly Scholer Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Partners in Autism

  • Behavior Analyst
  • Fort Wayne, IN
  • NPI 1104236272
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1527552000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1550188800000",
    "number": "1881185536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4103 CASTELL DR",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468352100",
            "telephone_number": "765-730-3691"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3030 LAKE AVE STE 20",
            "city": "FORT WAYNE",
            "state": "IN",
            "postal_code": "468055428",
            "telephone_number": "260-420-9332",
            "fax_number": "866-446-0198"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PHILLIPS",
        "first_name": "KELLY",
        "credential": "BCBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-05-29",
        "last_updated": "2019-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "IN",
            "license": "1-18-31563",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KELLY",
            "last_name": "SCHOLER",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Milissa C. Phillips-Bohlender, NP
• Abby Phillips
• Douglas Leon Phillips II, DO
• Heather Phillips, LMFT
• John R Phillips
• Kiarra Phillips
• Randall Joseph Phillips, MD
• Rhonda L Phillips, DO
• Robert Arthur Phillips II
• Sheri Lynn Phillips, BSN

• Behavior Analyst in Fort Wayne, IN
• Providers in Fort Wayne, IN by specialty
• Behavior Analyst in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 15, 2019; 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.