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NPI Code Detail

MEDICARE: KALEE ANN MIRACLE

MEDICARE: KALEE ANN MIRACLE
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1063150027
Entity Type Code : Individual
Provider Name (Legal Business Name) : KALEE ANN MIRACLE
Provider Business Mailing Address
First Line : 9146 HARRISON BAY RD
Second Line :
City : HARRISON
State : TN
Zip : 37341-9704
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 177 MOUSE CREEK RD NW
Second Line :
City : CLEVELAND
State : TN
Zip : 37312-3838
Country : US
Telephone Number : 888-963-2228
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/20/2022
Last Update Date : 05/09/2024

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Directions to “ KALEE ANN MIRACLE ” Practice Location

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