KRYSTLE DIANE CLARK (NPI# 1255948527) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1255948527 |
| Entity Type | Individual |
| Full Name | KRYSTLE DIANE CLARK |
| Credential | RBT |
| Practice Address |
200 Brookstone Centre Pkwy Bldg 200 Columbus GA 31904-4559 |
| Mailing Address |
3500 Depauw Blvd Ste 3070 Indianapolis IN 46268-6135 |
| Practice Telephone | 7622390017 |
| Practice Fax Number | 3175208200 |
| Mailing Telephone | 8553240885 |
| Mailing Fax Number | 3175208200 |
| Enumeration Date | 2020-09-30 |
| Last Update Date | 2020-09-30 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 106S00000X | Behavior Technician | RBT-20-132338 | GA | Behavioral Health & Social Service Providers |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1083994586 | Krystle Clark | Pharmacist | 3212 E Chinden Blvd, Eagle, ID 83616-6473 | 2011-08-28 |
| Street Address |
200 BROOKSTONE CENTRE PKWY BLDG 200 |
| City | COLUMBUS |
| State | GA |
| Zip Code | 31904-4559 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1710418173 | Amanda Barnette Pruett | Behavioral Analyst | 200 Brookstone Centre Pkwy Bldg 200, Columbus, GA 31904 | 2017-03-27 |
| 1568079846 | Diamond Elizabeth Baxter | Behavior Technician | 200 Brookstone Centre Pkwy Bldg 200, Columbus, GA 31904-4559 | 2020-09-30 |
| 1710594049 | Michelle Lynae Ellis | Behavior Technician | 200 Brookstone Centre Pkwy Bldg 200, Columbus, GA 31904-4559 | 2020-09-30 |
| 1306453717 | Claire Elizabeth Attyah | Behavior Technician | 200 Brookstone Centre Pkwy Bldg 200, Columbus, GA 31904-4559 | 2020-09-29 |
| 1588270185 | Shala S Upshaw | Behavior Technician | 200 Brookstone Centre Pkwy Bldg 200, Columbus, GA 31904-4559 | 2020-09-18 |
| 1164038097 | I'yhania Gabrielle Thomas | Behavior Technician | 200 Brookstone Centre Pkwy Bldg 200, Columbus, GA 31904-4559 | 2020-09-16 |
| 1003421702 | Abby Gail Roughton | Behavior Technician | 200 Brookstone Centre Pkwy Bldg 200, Columbus, GA 31904-4559 | 2020-09-10 |
| 1629682521 | Chelsey Lynne Evangeliste | Behavior Technician | 200 Brookstone Centre Pkwy Bldg 200, Columbus, GA 31904-4559 | 2020-09-08 |
| 1639788987 | Laweng Ann Ward | Behavior Technician | 200 Brookstone Centre Pkwy Bldg 200, Columbus, GA 31904-4559 | 2020-07-23 |
| 1710505375 | Misty Kay Johnson | Behavior Technician | 200 Brookstone Centre Pkwy Bldg 200, Columbus, GA 31904-4559 | 2020-07-10 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1821641457 | At Home Palliative Care, LLC | Nursing Care | 114 Enterprise Ct, Suite B, Columbus, GA 31904 | 2019-07-23 |
| 1285191049 | Shandra Ladell Grimes | Nurse Practitioner | 2300 Manchester Expwy St Francis Hospital, Suite C-001, Columbus, GA 31904 | 2019-02-27 |
| 1881161529 | Lesley Kathleen Simmons | Massage Therapist | 5402 15th Ave, Columbus, GA 31904 | 2018-10-31 |
| 1184190662 | Alphonsa Joseph | Nurse Practitioner | 2430 Brookstone Centre Parkway, Columbus, Georgia 31904, Columbus, GA 31904 | 2018-10-22 |
| 1568942704 | William Pearce Massey | Social Worker | 8851-1 Moore Road, Columbus, GA 31904 | 2018-08-17 |
| 1033696372 | Marlise V. Gray | Counselor | 2013 Devonshire Dr. Suite 115, Columbus, GA 31904 | 2018-07-19 |
| 1750833232 | Carrie Leigh Whitehead | Nurse Practitioner | 6228 Bradley Park Dr. Suite A, Columbus, GA 31904 | 2016-10-31 |
| 1609323369 | Shomika Lasha Battle | Registered Nurse | 2101 North Avenue, Columbus, GA 31904 | 2016-09-09 |
| 1952759219 | Peaceful River Home Care Agency | In Home Supportive Care | 738 Rudgate Road, Columbus, GA 31904 | 2016-05-27 |
| 1992180087 | I V Care of Middle Georgia Inc | Clinic/Center | 6001 River Rd, Suite 411, Columbus, GA 31904 | 2015-07-30 |
| Find all providers in zip 31904 | ||||
| Taxonomy Code | 106S00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavior Technician |
| The behavior technician is a paraprofessional who practices under the close, ongoing supervision of a behavior analyst or assistant behavior analyst certified by the Behavior Analyst Certification Board and/or credentialed by a state (such as through licensure). The behavior technician is primarily responsible for the implementation of components of behavior-analytic treatment plans developed by the supervisor. That may include collecting data on treatment targets and conducting certain types of behavioral assessments (e.g., stimulus preference assessments). The behavior technician does not design treatment or assessment plans or procedures but provides services as assigned by the supervisor responsible for his or her work. |
| Notes: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2016: new] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1760089627 | Leora A Sales | Behavior Technician | 3070 Riverside Dr, Ste 200, Columbus, Oh, Columbus, OH 43221 | 2020-10-05 |
| 1255948832 | Kayla Maree Pitzer | Behavior Technician | 1639 Bradley Park Dr Ste 500, Columbus, GA 31904-3623 | 2020-09-28 |
| 1225659055 | Nyesha Newsom | Behavior Technician | 5394 Ivywood Ln, Columbus, OH 43229-3909 | 2020-05-04 |
| 1437770708 | Erin M Beach | Behavior Technician | 3070 Riverside Dr Ste 400, Columbus, OH 43221-2547 | 2020-04-28 |
| 1790310001 | Mackenzie Ann Steitz | Behavior Technician | 3070 Riverside Dr # 200, Columbus, OH 43221-2547 | 2020-03-06 |
| 1891335352 | Dayana Banks | Behavior Technician | 3070 Riverside Dr Unit 200, Columbus, OH 43221-2547 | 2020-01-13 |
| 1730729401 | Sarah Hendricks | Behavior Technician | 2222 Poshard Dr, Columbus, IN 47203-1843 | 2020-01-10 |
| 1740821362 | Luke Marcus Ekstrom | Behavior Technician | 1349 Warren Williams Rd, Columbus, GA 31901-2630 | 2019-10-04 |
| 1972152122 | Emily Grace Rhodes | Behavior Technician | 3575 Macon Rd Ste 11, Columbus, GA 31907-8228 | 2019-09-10 |
| 1295387892 | Dewaynia Traniese Farrow | Behavior Technician | 1709 Bunker Hill Rd, Columbus, GA 31907-6719 | 2019-07-12 |
| Find all providers in COLUMBUS | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.