MEDICARE: NYOKA ANDERSON MS, RBT

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
1	106S00000X	Behavior Technician	RBT-22-203399	TX

General Provider Information

NPI Number	:	1336886621
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NYOKA ANDERSON MS, RBT

Provider Business Mailing Address
First Line	:	3330 EASTPARK BLVD APT 1302
Second Line	:
City	:	DENTON
State	:	TX
Zip	:	76201-1551
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2825 VALLEY VIEW LN STE 100
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75234-4943
Country	:	US
Telephone Number	:	214-736-8376
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/18/2022
Last Update Date	:	05/18/2022

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