Active NPI
Dalton Luke Fongemie
- Behavior Technician
- Doniphan, MO
National Provider Identifier
1972336766
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 966 US Highway 160 E
Doniphan, MO 63935-7113 - Phone
- (573) 996-2203
- NPI assigned
- Aug 26, 2024
- Sex
- Male
- Sole proprietor
- No
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 | Primary |
Addresses
Primary practice location
966 US Highway 160 E
Doniphan, MO 63935-7113
Mailing address
966 US Highway 160 E
Doniphan, MO 63935-7113
Phone (573) 996-2203
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.
-
- Primary Care Clinic/Center
- Poplar Bluff, MO
- NPI 1235738493
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
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Family Counseling Center, Inc. | Past | Accepting new patients |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1724630400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1724630400000",
"number": "1972336766",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "966 US HIGHWAY 160 E",
"city": "DONIPHAN",
"state": "MO",
"postal_code": "639357113",
"telephone_number": "573-996-2203"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "966 US HIGHWAY 160 E",
"city": "DONIPHAN",
"state": "MO",
"postal_code": "639357113",
"telephone_number": "573-996-2203"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONGEMIE",
"first_name": "DALTON",
"middle_name": "LUKE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2024-08-26",
"last_updated": "2024-08-26",
"certification_date": "2024-08-26",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": null,
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Doniphan, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 26, 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.