Individual provider Active NPI

Kylie Rose Buongiorne

  • Behavior Analyst
  • Fredericksburg, VA
National Provider Identifier
1922660372
Registry record updated Aug 24, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
0133003142 Issued in VA
Practice address
904 Princess Anne St Ste 407
Fredericksburg, VA 22401-5804
Phone
(540) 479-3889
NPI assigned
Jul 6, 2019
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 24, 2023

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X 0133003142 VA Primary

Addresses

Primary practice location

904 Princess Anne St Ste 407
Fredericksburg, VA 22401-5804

Mailing address

904 Princess Anne St Ste 407
Fredericksburg, VA 22401-5804
Phone (540) 479-3889

Other names 1

  • Kylie Rose Wyckoff Former name

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
0133003142VAMDBehavioral Analyst

Practice roles

OrganizationSpecialtyStatusNew patients
Paragon Autism Services, LLC Behavior Analyst PastSince Sep 5, 2023 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": "1562371200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1692835200000",
    "number": "1922660372",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "904 PRINCESS ANNE ST STE 407",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224015804",
            "telephone_number": "540-479-3889",
            "fax_number": "540-479-3946"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "904 PRINCESS ANNE ST STE 407",
            "city": "FREDERICKSBURG",
            "state": "VA",
            "postal_code": "224015804",
            "telephone_number": "540-479-3889"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BUONGIORNE",
        "first_name": "KYLIE",
        "middle_name": "ROSE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-07-06",
        "last_updated": "2023-08-24",
        "certification_date": "2023-08-24",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "VA",
            "license": "0133003142",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KYLIE",
            "last_name": "WYCKOFF",
            "middle_name": "ROSE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Fredericksburg, VA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 24, 2023; 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.