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Deactivated NPI 1134623663 Deactivated / Inactive NPI Female Practitioner

Nicole Johnson , BCBA

Behavior Analyst • Honolulu, HI

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Notice of NPI Deactivation & Inactive Practice Status

According to official public domain records published by CMS (Centers for Medicare & Medicaid Services) in the National Provider Identifier (NPPES) Registry, Nicole Johnson has officially deactivated this NPI record and ceased active healthcare practice.

Registration / Start Date March 20, 2018
NPI Deactivation Date December 07, 2022
Total Practice Duration ~4 Years of Practice (2018 – 2022)

Professional Overview & Biography Verified Profile Summary

Nicole Johnson, BCBA was a registered Behavior Analyst practicing in Honolulu, HI. Throughout an active medical career spanning 4 years, Nicole Johnson provided care at the practice location at 200 N VINEYARD BLVD STE A330 until profile deactivation on 2022-12-07.

Practice Location & Contact Primary Location

Practice Address

200 N Vineyard Blvd Ste A330

Honolulu, HI 968173950

Telephone 8084250195
Fax 8083697106
Associated Practice Facility / Clinic

Specialty Benchmarks & Practice Insights

Comparative analytics for Behavior Analyst in Honolulu, HI

Active Practitioner
Practitioner Clinical Experience
Active
City Avg: 8.5 Yrs
State Avg: 8.5 Yrs
Regional Practice Density
377 Specialists

Practicing in Honolulu, HI (924 Statewide)

Telehealth Adoption Rate
0.0% Regional Adoption

In-Person Office Visits Only

Medicare Pricing Discount
67.4% Avg Savings

Under CMS Medicare Fee Schedule vs Standard Submitted Charges

Medical Specialties & State Licenses

CMS Verified: 2024-12-12
Behavior Analyst Primary Specialty

NUCC Taxonomy Code: 103K00000X

State License CO 1-19-36053

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.

Practice Associates & Co-Workers

Healthcare professionals and specialists practicing at this location or sharing practice phone/fax

18 Associated Practitioners
Yuko Bowie

Behavior Technician

NPI 1053019604
Ashlyn Chang

Behavior Technician

NPI 1053297358
Brooke Fetterolf

Behavior Technician

NPI 1093418030
Huan He

Behavior Technician

NPI 1164129664
Karla Montemayor

Behavior Technician

NPI 1245005719
Sam Schechter

Behavior Technician

NPI 1245924505

Career & Practice History Timeline

Chronological log of verified NPI updates, location relocations, credentials, and registry changes

22 Historical Events
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Updated Practice Location December 12, 2024

Registered at 200 N VINEYARD BLVD STE A330, HONOLULU, HI 968173950 (Tel: 8084250195)

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Updated Business Mailing Address December 12, 2024

Registered at 200 N VINEYARD BLVD STE A330, HONOLULU, HI 968173950 (Tel: 8084250195)

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Updated Practice Location January 09, 2023

Registered at 126 AIKAHI LOOP, KAILUA, HI 967341642 (Tel: 8084250195)

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Updated Business Mailing Address January 09, 2023

Registered at 126 AIKAHI LOOP, KAILUA, HI 967341642 (Tel: 8084250195)

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Updated Practice Location December 30, 2022

Registered at 94-849 LUMIAINA ST UNIT 201, WAIPAHU, HI 967975677 (Tel: 7204962605)

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Updated Business Mailing Address December 30, 2022

Registered at 16782 VON KARMAN AVE STE 11, IRVINE, CA 926062417 (Tel: 6195506368)

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Provider Name / Credentials Updated December 30, 2022

Recorded as NICOLE JOHNSON, BCBA

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Medical Taxonomy / Specialty Registered (Primary Specialty) December 30, 2022

Behavior Analyst (License #1-19-36053 in CO)

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NPI Profile Deactivated December 07, 2022

Record deactivated on December 07, 2022

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Updated Practice Location March 15, 2021

Registered at 94-849 LUMIAINA ST UNIT 201, WAIPAHU, HI 967975677 (Tel: 7204962605)

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Updated Business Mailing Address March 15, 2021

Registered at 16782 VON KARMAN AVE STE 11, IRVINE, CA 926062417 (Tel: 6195506368)

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Provider Name / Credentials Updated June 18, 2019

Recorded as NICOLE JOHNSON, BCBA

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Medical Taxonomy / Specialty Registered (Primary Specialty) June 18, 2019

Behavior Analyst (License #1-19-36053 in CO)

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Updated Practice Location January 15, 2019

Registered at 9299 EASTMAN PARK DR, WINDSOR, CO 805503318 (Tel: 7204962605)

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Updated Business Mailing Address January 15, 2019

Registered at 2001 ROSEN DR APT 5-201, FORT COLLINS, CO 805282011 (Tel: 2077124001)

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Provider Name / Credentials Updated January 15, 2019

Recorded as NICOLE JOHNSON, RBT

NPI Profile Active March 20, 2018

NPI status registered as active in NPPES database

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Updated Practice Location March 20, 2018

Registered at 1200 W SOUTH BOULDER RD STE 204, LAFAYETTE, CO 800262833 (Tel: 7208372348)

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Updated Business Mailing Address March 20, 2018

Registered at PO BOX 271690, LOUISVILLE, CO 800275035 (Tel: 7208372348)

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Provider Name / Credentials Updated March 20, 2018

Recorded as NICOLE STAPLES, RBT

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Medical Taxonomy / Specialty Registered (Primary Specialty) March 20, 2018

Behavior Technician (License #17-29083 in CO)

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Initial NPI Registration & Enumeration March 20, 2018

First registered as active Individual Practitioner in NPPES Database.

Patient & Community Reviews

Verified patient ratings, medical care experiences, and facility photos

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NPI Administrative Meta

NPI Number: 1134623663
Entity Type:
Individual Provider Physician, Nurse Practitioner, or Solo Healthcare Professional (Type 1 NPI)
Enumeration Date: March 20, 2018
Last Update: December 12, 2024
Deactivation Date: December 07, 2022
Sole Proprietor: No

Mailing Address

200 N Vineyard Blvd Ste A330

Honolulu, HI 968173950

Phone: 8084250195

Public Domain Record This profile contains public domain information published by CMS and NPPES under the Freedom of Information Act (FOIA).
⚠️ Medical Disclaimer

This directory listing is for informational purposes only and does not constitute medical advice, diagnosis, or physician endorsement. If you are experiencing a medical emergency, please call 911 immediately.