Healthcare Provider Details

I. General information

NPI: 1083335392
Provider Name (Legal Business Name): AUSTIN JAMES, ROBERT DAVIS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2022
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 E GALLUP HILL RD
NIXA MO
65714-8864
US

IV. Provider business mailing address

705 E GALLUP HILL RD
NIXA MO
65714-8864
US

V. Phone/Fax

Practice location:
  • Phone: 833-624-6385
  • Fax:
Mailing address:
  • Phone: 833-624-6385
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number0-23-14936
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-22-232276
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: