Active NPI
Michele Elizabeth Derouen, BSPTA
- Behavior Technician
- Alamogordo, NM
National Provider Identifier
1992049795
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Behavior Technician
- Practice address
- 27 Calle de Suenos
Alamogordo, NM 88310-9501 - Phone
- (575) 491-1500
- NPI assigned
- Nov 16, 2012
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Behavior Technician | 106S00000X | NM | Primary | |
| Physical Therapy Assistant | 225200000X | A-0719 | NM |
Addresses
Primary practice location
27 Calle de Suenos
Alamogordo, NM 88310-9501
Mailing address
511 Utah Ave
Alamogordo, NM 88310-5932
Phone (575) 491-1500
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 |
|---|---|---|---|
| A-0719 | NM | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1353024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1649894400000",
"number": "1992049795",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "511 UTAH AVE",
"city": "ALAMOGORDO",
"state": "NM",
"postal_code": "883105932",
"telephone_number": "575-491-1500"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "27 CALLE DE SUENOS",
"city": "ALAMOGORDO",
"state": "NM",
"postal_code": "883109501",
"telephone_number": "575-491-1500"
}
],
"practiceLocations": [],
"basic": {
"last_name": "DEROUEN",
"first_name": "MICHELE",
"middle_name": "ELIZABETH",
"name_prefix": "Ms.",
"credential": "BSPTA",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2012-11-16",
"last_updated": "2022-04-14",
"certification_date": "2022-04-14",
"status": "A"
},
"taxonomies": [
{
"code": "106S00000X",
"taxonomy_group": "",
"desc": "Behavior Technician",
"state": "NM",
"license": null,
"primary": true
},
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "NM",
"license": "A-0719",
"primary": false
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Alamogordo, NM
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 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.