1073077384 NPI number — ROBYN KAE NELSON MA, BCBA

Table of content: ROBYN KAE NELSON MA, BCBA (NPI 1073077384)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073077384 NPI number — ROBYN KAE NELSON MA, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NELSON
Provider First Name:
ROBYN
Provider Middle Name:
KAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ORTH
Provider Other First Name:
ROBYN
Provider Other Middle Name:
KAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1073077384
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/31/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12650 HAMILTON CROSSING BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CARMEL
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46032-5400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-249-2242
Provider Business Mailing Address Fax Number:
317-663-1175

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12650 HAMILTON CROSSING BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CARMEL
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46032-5400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-249-2242
Provider Business Practice Location Address Fax Number:
317-663-1175
Provider Enumeration Date:
01/31/2019

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)