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NPI Code Detail

MEDICARE: JESSI ELIZABETH HERNANDEZ BCBA

MEDICARE: JESSI ELIZABETH HERNANDEZ BCBA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst1-21-52190CO
2106S00000XBehavior Technician

General Provider Information

NPI Number : 1194378828
Entity Type Code : Individual
Provider Name (Legal Business Name) : JESSI ELIZABETH HERNANDEZ BCBA
Provider Business Mailing Address
First Line : 819 TARA PLZ
Second Line :
City : PAPILLION
State : NE
Zip : 68046-2043
Country : US
Telephone Number : 907-206-4450
Fax Number :
Provider Business Practice Location Address
First Line : 819 TARA PLZ
Second Line :
City : PAPILLION
State : NE
Zip : 68046-2043
Country : US
Telephone Number : 907-206-4450
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/22/2019
Last Update Date : 01/10/2023

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