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NPI Code Detail

MEDICARE: MRS. NYETTA SHANEE ABERNATHY M.ED, BCBA, LBA

MEDICARE: MRS. NYETTA SHANEE ABERNATHY M.ED, BCBA, LBA
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
1106S00000XBehavior TechnicianRBT-20-110527NV
2225400000XRehabilitation Practitioner
3103K00000XBehavior Analyst1-21-56396NV

General Provider Information

NPI Number : 1508158635
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. NYETTA SHANEE ABERNATHY M.ED, BCBA, LBA
Provider Business Mailing Address
First Line : 3320 SALMON CREEK DR
Second Line :
City : LAS VEGAS
State : NV
Zip : 89129-6186
Country : US
Telephone Number : 702-526-7541
Fax Number :
Provider Business Practice Location Address
First Line : 630 S RANCHO DR STE A
Second Line :
City : LAS VEGAS
State : NV
Zip : 89106-4849
Country : US
Telephone Number : 702-998-9505
Fax Number : 702-527-7939
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/08/2011
Last Update Date : 02/03/2022

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