Provider Demographics
NPI:1508158635
Name:ABERNATHY, NYETTA SHANEE (MED, BCBA, LBA)
Entity Type:Individual
Prefix:MRS
First Name:NYETTA
Middle Name:SHANEE
Last Name:ABERNATHY
Suffix:
Gender:F
Credentials:MED, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3320 SALMON CREEK DR
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89129-6186
Mailing Address - Country:US
Mailing Address - Phone:702-526-7541
Mailing Address - Fax:
Practice Address - Street 1:630 S RANCHO DR STE A
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4849
Practice Address - Country:US
Practice Address - Phone:702-998-9505
Practice Address - Fax:702-527-7939
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-08
Last Update Date:2022-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-20-110527106S00000X
225400000X
NV1-21-56396103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner