Individual provider Active NPI

Waylon Joseph Raether

  • Behavior Analyst
  • Las Vegas, NV
National Provider Identifier
1992107957
Registry record updated Sep 22, 2014
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
1602436870 Issued in NV
Practice address
6600 W Charleston Blvd Ste 140
Las Vegas, NV 89146-1067
Phone
(702) 437-4673
NPI assigned
Sep 22, 2014
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 22, 2014

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 1602436870 NV Primary

Addresses

Primary practice location

6600 W Charleston Blvd Ste 140
Las Vegas, NV 89146-1067

Mailing address

6600 W Charleston Blvd Ste 140
Las Vegas, NV 89146-1067

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
1602436870NVMDBehavioral Analyst

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1411344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1411344000000",
    "number": "1992107957",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6600 W CHARLESTON BLVD STE 140",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891461067"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6600 W CHARLESTON BLVD STE 140",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891461067",
            "telephone_number": "702-437-4673"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "RAETHER",
        "first_name": "WAYLON",
        "middle_name": "JOSEPH",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2014-09-22",
        "last_updated": "2014-09-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NV",
            "license": "1602436870",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Las Vegas, NV

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 22, 2014; 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.