MICHELLE LYNAE ELLIS BA, RBT
Complete NPI Record 1710594049
Behavior Technician in Ponte Vedra Beach, FL
Active since September 30, 2020
Complete NPI Dataset
This page contains the complete raw NPPES record for Michelle Lynae Ellis, BA, RBT (NPI 1710594049), an individual behavior technician provider in Ponte Vedra Beach, FL. All 32 fields on file are listed with their current values and official NPPES definitions, exactly as recorded in the National Plan and Provider Enumeration System. Only fields that contain data are included, so the number of fields shown varies from one NPI record to another.
Use the tools below to filter fields by category, search within the record, or jump straight to a specific field. You can download the full record as a CSV, JSON, or text file, or filter first and export only the fields you need. The Print Clean Summary button produces a printer-friendly copy of the record.
Registry File Document Utilities
- NPI: 1710594049 Field 1/32
- The 10-position all-numeric identification number assigned by the NPS to uniquely identify a health care provider. The NPI number includes an ISO standard check-digit in the 10th position. There is no intelligence about the health care provider in the number.
- Entity Type Code: 1 Field 2/32
- Code describing the type of health care provider that is being assigned an NPI. Codes are 1 = (Person): individual human being who furnishes health care; 2 = (Non-person): entity other than an individual human being that furnishes health care (for example, hospital, SNF, hospital subunit, pharmacy, or HMO).
- Provider Last Name Legal Name: ELLIS Field 3/32
- The last name of the provider. If the provider is an individual, this is the legal name.
- Provider First Name: MICHELLE Field 4/32
- The first name of the provider, if the provider is an individual.
- Provider Middle Name: LYNAE Field 5/32
- The middle name of the provider, if the provider is an individual.
- Provider Credential Text: BA, RBT Field 6/32
- The abbreviations for professional degrees or credentials used or held by the provider, if the provider is an individual. Examples are MD, DDS, CSW, CNA, AA, NP, RNA, or PSY. These credential designations will not be verified by NPS.
- Provider Other Last Name: PERKINS Field 7/32
- Other last name by which the provider being identified is or has been known.
- Provider Other First Name: MICHELLE Field 8/32
- Other first name by which the provider being identified is or has been known (if an individual). This may be the same as the "Provider first name" if the provider is or has been known by a different last name only.
- Provider Other Middle Name: LYNAE Field 9/32
- Other middle name by which the provider being identified is or has been known (if an individual). This may be the same as the "Provider middle name" if the provider is or has been known by a different last name only.
- Provider Other Last Name Type Code: 1 Field 10/32
- Code identifying the type of other name. Codes are: 1 = former name; 2 = professional name; 3 = doing business as (d/b/ a) name; 4 = former legal business name; 5 = other.
- Provider First Line Business Mailing Address: 130 CORRIDOR RD UNIT 3929 Field 11/32
- The first line mailing address of the provider being identified. This data element may contain the same information as "Provider first line location address".
- Provider Business Mailing Address City Name: PONTE VEDRA Field 12/32
- The city name in the mailing address of the provider being identified.
- Provider Business Mailing Address State Name: FL Field 13/32
- The State or Province name in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address State name".
- Provider Business Mailing Address Postal Code: 320047850 Field 14/32
- The postal ZIP or zone code in the mailing address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available. This data element may contain the same information as "Provider location address postal code".
- Provider Business Mailing Address Country Code If outside U S : US Field 15/32
- The country code in the mailing address of the provider being identified. This data element may contain the same information as "Provider location address country code".
- Provider First Line Business Practice Location Address: 130 CORRIDOR RD UNIT 3929 Field 16/32
- The first line location address of the provider being identified. For providers with more than one physical location, this is the primary location. This address cannot include a Post Office box.
- Provider Business Practice Location Address City Name: PONTE VEDRA BEACH Field 17/32
- The city name in the location address of the provider being identified.
- Provider Business Practice Location Address State Name: FL Field 18/32
- The State code in the location of the provider being identified.
- Provider Business Practice Location Address Postal Code: 320047850 Field 19/32
- The postal ZIP or zone code in the location address of the provider being identified. NOTE: ZIP code plus 4-digit extension, if available.
- Provider Business Practice Location Address Country Code If outside U S : US Field 20/32
- The country code in the location address of the provider being identified.
- Provider Business Practice Location Address Telephone Number: 2543835991 Field 21/32
- The telephone number associated with the location address of the provider being identified.
- Provider Gender Code: F Field 24/32
- The code designating the provider's gender if the provider is a person.
- Healthcare Provider Taxonomy Code 1: 106S00000X Field 25/32
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Healthcare Provider Primary Taxonomy Switch 1: N Field 26/32
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Healthcare Provider Taxonomy Code 2: 106S00000X Field 27/32
- This field represents the provider's taxonomy code, which classifies their type, classification, and area of specialization. This code comes from the Healthcare Provider Taxonomy Code Set maintained by the National Uniform Claim Committee (NUCC). The NPS will associate these data with the license data for providers with Entity type code = 1.
- Provider License Number 2: RBT-20-133340 Field 28/32
- The license number issued to the provider being identified. The NPS can accommodate multiple license numbers for multiple specialties and for multiple States. The NPS will associate this data element with "provider taxonomy code".
- Provider License Number State Code 2: GA Field 29/32
- The two-letter state code representing the U.S. state or territory that issued the provider's license. This field is linked to the Provider License Number field and identifies the jurisdiction where that license is valid. A provider may have multiple state codes if they hold licenses in more than one state.
- Healthcare Provider Primary Taxonomy Switch 2: Y Field 30/32
- This field shows whether the related taxonomy code is the provider's primary specialty. It is a single-character value: "Y" indicates the taxonomy is the primary one, while "N" indicates it is not. Each provider record can have only one taxonomy code marked as primary.
- Is Sole Proprietor: N Field 31/32
- Indicates whether the provider is registered as a sole proprietor. This is a single-character code: "Y" means the provider operates as a sole proprietor, and "N" means they do not.
Secondary Practice Locations 1
The first line of the secondary practice location address of the provider being identified. For providers with more than one physical location, this is a secondary practice location address. This address cannot include a Post Office box.
200 Brookstone Centre Pkwy Bldg 200
Location 1/1Columbus, GA 31904-4559 · Phone (762) 239-0017 · Fax (317) 520-8200
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