Individual provider Active NPI

Wesley James Van Canon

  • Behavior Technician
  • Dade City, FL
National Provider Identifier
1902780463
Registry record updated Aug 5, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior TechnicianTaxonomy code 106S00000X
License
RBT-25-439381 Issued in FL
Practice address
13424 Fort King Rd
Dade City, FL 33525-5214
Phone
(352) 437-3559
NPI assigned
Aug 5, 2025
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Aug 5, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X RBT-25-439381 FL Primary

Addresses

Primary practice location

13424 Fort King Rd
Dade City, FL 33525-5214

Mailing address

2712 Buckhorn Oaks Dr
Valrico, FL 33594-4201
Phone (863) 258-9098

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-25-439381FLMDBehavior Technician

Practice roles

OrganizationSpecialtyStatusNew patients
Luminescence Therapy LLC CurrentSince Aug 10, 2025 Accepting new patients

Locations

13424 Fort King Rd
Dade City, FL 33525
Phone (352) 347-3559

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": "1754352000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1754352000000",
    "number": "1902780463",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2712 BUCKHORN OAKS DR",
            "city": "VALRICO",
            "state": "FL",
            "postal_code": "335944201",
            "telephone_number": "863-258-9098"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13424 FORT KING RD",
            "city": "DADE CITY",
            "state": "FL",
            "postal_code": "335255214",
            "telephone_number": "352-437-3559"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "VAN CANON",
        "first_name": "WESLEY",
        "middle_name": "JAMES",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2025-08-05",
        "last_updated": "2025-08-05",
        "certification_date": "2025-08-05",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "RBT-25-439381",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Dade City, FL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 5, 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.

Verify at the official NPI Registry.