DataLabs
datalabs.health made in the usa
DataLabs Facebook Wall   Like   Follow DataLabs on Twitter   Tweet  
Contact us Sign in |  Documentation | 
NPI Code Detail

MEDICARE: KRISTEN ANN CLARK BCBA

MEDICARE: KRISTEN ANN CLARK BCBA
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 Analyst1-20-41435FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1063749679
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTEN ANN CLARK BCBA
Provider Business Mailing Address
First Line : 11200 CALLAWAY GREENS DR
Second Line :
City : FORT MYERS
State : FL
Zip : 33913-8139
Country : US
Telephone Number : 239-850-3679
Fax Number :
Provider Business Practice Location Address
First Line : 12438 BRANTLEY COMMONS CT
Second Line :
City : FORT MYERS
State : FL
Zip : 33907-5683
Country : US
Telephone Number : 239-850-3679
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/03/2009
Last Update Date : 05/06/2025

Similar Medicare Providers

1336092311 — ISABELLA CORDERO
Practice Location Address:
12438 BRANTLEY COMMONS CT
FORT MYERS, FL
33907-5683
Practice Phone: 239-270-5921
Practice Fax: 239-205-8889
1861342412 — EMILY SUE PEPE
Practice Location Address:
12438 BRANTLEY COMMONS CT
FORT MYERS, FL
33907-5683
Practice Phone: 239-270-5921
Practice Fax:
1821114356 — MRS. IRELIS DELGADO-HERNANDEZ
Practice Location Address:
12438 BRANTLEY COMMONS CT
FORT MYERS, FL
33907-5683
Practice Phone: 239-349-3139
Practice Fax: 239-984-4372
1588081301 — LAUREN A. LOVELL INC
Practice Location Address:
12438 BRANTLEY COMMONS COURT
FORT MYERS, FL
33907-5683
Practice Phone: 239-270-5921
Practice Fax: 855-796-6622
1609383975 — KAILA PERRINGTON
Practice Location Address:
12438 BRANTLEY COMMONS CT
FORT MYERS, FL
33907-5683
Practice Phone: 239-349-3139
Practice Fax: 239-984-4372
1346881794 — KIMBERLY MARTINEZ RBT
Practice Location Address:
12438 BRANTLEY COMMONS CT
FORT MYERS, FL
33907-5683
Practice Phone: 239-349-3139
Practice Fax: 239-984-4372

Directions to “ KRISTEN ANN CLARK BCBA” Practice Location

Language Start Address Practice Location
These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

Copyright © 2007-2026 (Powered by Swiss Vault Engine), all rights reserved. HIPAA liability, trademark, document use and software licensing rules apply. All registered trademarks, used in the content, are the property of their owners. Your interactions with this site are in accordance with our Terms of Use and Privacy Policy.