Individual provider Active NPI

Morgan Louise Pristupa

  • Behavior Analyst
  • Jacksonville, FL
National Provider Identifier
1902363351
Registry record updated Aug 15, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
Practice address
13121 Atlantic Blvd Ste 200
Jacksonville, FL 32225-0102
Phone
(904) 491-2111
NPI assigned
Feb 21, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2024

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X RBT-19-77952 FL
Behavior Analyst 103K00000X Primary

Addresses

Primary practice location

13121 Atlantic Blvd Ste 200
Jacksonville, FL 32225-0102

Mailing address

7932 Altama Rd
Jacksonville, FL 32216-9315
Phone (904) 318-5955

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

LicenseStateTypeSpecialty
RBT-19-77952FLMDBehavior Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Proactive Life Skills LLC Past Accepting new patients

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 and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1550707200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1723680000000",
    "number": "1902363351",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7932 ALTAMA RD",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322169315",
            "telephone_number": "904-318-5955"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13121 ATLANTIC BLVD STE 200",
            "city": "JACKSONVILLE",
            "state": "FL",
            "postal_code": "322250102",
            "telephone_number": "904-491-2111"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PRISTUPA",
        "first_name": "MORGAN",
        "middle_name": "LOUISE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-21",
        "last_updated": "2024-08-15",
        "certification_date": "2024-08-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "RBT-19-77952",
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Jacksonville, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2024; 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.