Active NPI
Jordan Terrell Peppers
- Behavior Technician
- Elk Grove, CA
National Provider Identifier
1972212868
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- License
- 00017943
- Practice address
- 2366 Maritime Dr
Elk Grove, CA 95758-3639 - Phone
- (916) 215-5754
- NPI assigned
- Nov 18, 2022
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | 00017943 | CA | Primary |
Addresses
Primary practice location
2366 Maritime Dr
Elk Grove, CA 95758-3639
Mailing address
6550 Kenbridge St
Elk Grove, CA 95758-6313
Phone (916) 215-5754
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
| License | State | Type | Specialty |
|---|---|---|---|
| 00017943 | CA | MD | Behavior Technician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1668729600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1668729600000",
"number": "1972212868",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6550 KENBRIDGE ST",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957586313",
"telephone_number": "916-215-5754"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2366 MARITIME DR",
"city": "ELK GROVE",
"state": "CA",
"postal_code": "957583639",
"telephone_number": "916-215-5754"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PEPPERS",
"first_name": "JORDAN",
"middle_name": "TERRELL",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2022-11-18",
"last_updated": "2022-11-18",
"certification_date": "2022-11-18",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "CA",
"license": "00017943",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Elk Grove, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 18, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.