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NPI Code Detail

MEDICARE: KENNETH JAMES KILLINGSWORTH M.A., BCBA, LBA

MEDICARE: KENNETH JAMES KILLINGSWORTH M.A., BCBA, LBA
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
1385H00000XRespite Care
2103K00000XBehavior AnalystLBA0092NV

General Provider Information

NPI Number : 1104375096
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENNETH JAMES KILLINGSWORTH M.A., BCBA, LBA
Provider Business Mailing Address
First Line : 3785 BAKER LN STE 201
Second Line :
City : RENO
State : NV
Zip : 89509-5454
Country : US
Telephone Number : 775-996-3890
Fax Number :
Provider Business Practice Location Address
First Line : 3785 BAKER LN STE 201
Second Line :
City : RENO
State : NV
Zip : 89509-5454
Country : US
Telephone Number : 775-996-3890
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/03/2016
Last Update Date : 12/19/2022

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