DR. MARK WILDMON (NPI# 1922654912) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1922654912 |
| Entity Type | Individual |
| Full Name | DR. MARK WILDMON |
| Credential | PH.D. |
| Practice Address |
447 Road 1279 Tupelo MS 38804-9653 |
| Practice Telephone | 6625232527 |
| Mailing Telephone | 6625232527 |
| Enumeration Date | 2019-08-14 |
| Last Update Date | 2019-08-14 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 103K00000X | Behavioral Analyst | 190077 | MS | Behavioral Health & Social Service Providers |
| Street Address |
447 ROAD 1279 |
| City | TUPELO |
| State | MS |
| Zip Code | 38804-9653 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1548874159 | Susan Me'chelle Oliver | Nurse Practitioner | 874 Barnes Crossing Road, Tupelo, MS 38804 | 2020-09-01 |
| 1134762784 | Kimberly J Adams | Occupational Therapy Assistant | 90 Clark Ave, Tupelo, MS 38804 | 2019-10-25 |
| 1790270924 | Megan Guntharp | Occupational Therapist | 960 Commonwealth Boulevard, Tupelo, MS 38804 | 2018-06-29 |
| 1154867562 | Urologic Ambulatory Surgery Center, LLC | Clinic/Center | 3353 N Gloster Street, Suite 300, Tupelo, MS 38804 | 2017-01-09 |
| 1790235919 | Dr Scott Dickinson D.m. D. PC | Dentist | 3999 N Gloster Street, Tupelo, MS 38804 | 2016-10-12 |
| 1326496621 | Angela Estes | Occupational Therapist | County Road 1279 House#197, Tupelo, MS 38804 | 2016-05-26 |
| 1316300080 | Eric Wade Tillotson | Family Medicine | 1665 South Green Street, Tupelo, MS 38804 | 2016-03-31 |
| 1104238898 | Stella M. Johnson | Social Worker | 2292 Camelot Cir, Tupelo, MS 38804 | 2014-05-29 |
| 1821437351 | Lenka Petersen | Student in an Organized Health Care Education/Training Program | 1665 S Green St., Nmmc, Tupelo, MS 38804 | 2013-06-18 |
| 1083966303 | Jessica M Baskett | Counselor | 398 E Main St, Tupelo, MS 38804 | 2012-10-10 |
| Find all providers in zip 38804 | ||||
| Taxonomy Code | 103K00000X |
| Grouping | Behavioral Health & Social Service Providers |
| Classification | Behavioral Analyst |
| A behavior analyst is qualified by at least a master’s degree and Behavior Analyst Certification Board certification and/or a state-issued credential (such as a license) to practice behavior analysis independently. Behavior analysts provide the required supervision to assistant behavior analysts and behavior technicians. A behavior analyst delivers services consistent with the dimensions of applied behavior analysis. Common services may include, but are not limited to, conducting behavioral assessments, analyzing data, writing and revising behavior-analytic treatment plans, training others to implement components of treatment plans, and overseeing implementation of treatment plans. |
| Notes: Source: Association of Professional Behavior Analysts, www.apbahome.net and Behavior Analyst Certification Board (http://www.bacb.com) [7/1/2008: new, 1/1/2016: modified definition] |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790155414 | Olivia Stanton | Behavioral Analyst | 143 S Thomas St Ste C, Tupelo, MS 38801-4349 | 2015-10-07 |
| 1396114351 | Jordan Johnson | Behavioral Analyst | 146 S Thomas St Ste E, Tupelo, MS 38801-5328 | 2015-09-21 |
| 1386027639 | Haley Jordyn Wood | Behavioral Analyst | 146 S Thomas St Ste C, Tupelo, MS 38801-5328 | 2015-07-06 |
| 1790152429 | Bonnie Coley | Behavioral Analyst | 146 S Thomas St, Suite C, Tupelo, MS 38801 | 2015-08-28 |
| 1336516558 | Emilee Kennedy | Behavioral Analyst | 146 S Thomas St, Suite E, Tupelo, MS 38801-5328 | 2015-08-24 |
| 1588030365 | Ekaterina Elizabeth Evans | Behavioral Analyst | 146 S Thomas St, Tupelo, MS 38801-5328 | 2015-08-17 |
| 1689057788 | Jeffrey Ryan Oliver | Behavioral Analyst | 146 S Thomas St, Suite C, Tupelo, MS 38801-5328 | 2015-07-07 |
| 1508103102 | Sharon Dugas Boudreaux | Behavioral Analyst | 146 S Thomas St, Ste. E, Tupelo, MS 38801-5328 | 2013-01-16 |
| 1598002198 | Jessyi Bryant Reed | Behavioral Analyst | 146 S Thomas St, Suite C, Tupelo, MS 38801-5328 | 2013-01-16 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1679170906 | Brian Michael Cline | Behavioral Analyst | 302 Mitchell St, Petal, MS 39465-2414 | 2020-10-09 |
| 1881207785 | Fredricca Jazzman Brock | Behavioral Analyst | 8481 Regal Bend Dr, Olive Branch, MS 38654-4416 | 2020-08-28 |
| 1376188086 | Marshall Devolopmental Therapy Services Inc | Behavioral Analyst | 308 Estes Mill Rd, Walnut Grove, MS 39189-5043 | 2019-11-18 |
| 1609418896 | Blue Sky Behavior Therapy | Behavioral Analyst | 402b Legacy Park, Ridgeland, MS 39157-4315 | 2019-10-09 |
| 1134697790 | Donna Satterlee Ross | Behavioral Analyst | 5779 Getwell Rd # 3, Southaven, MS 38672-6347 | 2018-11-12 |
| 1073098877 | Lana Kathryn Warren | Behavioral Analyst | 2180 Oak Grove Rd, Hattiesburg, MS 39402 | 2018-09-27 |
| 1326523168 | Mark G Yeager | Behavioral Analyst | 2180 Oak Grove Rd., Hattiesburg, MS 39402 | 2018-09-27 |
| 1205336930 | Deterrence Deon Allen | Behavioral Analyst | 7105 Swinnea Rd Ste 2, Southaven, MS 38671-6012 | 2018-02-19 |
| 1154820405 | Karlie Michelle Robinson | Behavioral Analyst | 5412 Lakeland Dr Ste C, Flowood, MS 39232-7136 | 2018-02-01 |
| 1952817157 | Mary Beth Welch | Behavioral Analyst | 9230 Old Lorraine Rd, Gulfport, MS 39503 | 2017-12-26 |
| Find all providers with the same taxonomy | ||||
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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.