MEDICARE: KIMBERLY DANIELLE DONNELLY 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
1	103K00000X	Behavior Analyst	0133003927	VA

General Provider Information

NPI Number	:	1215660063
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY DANIELLE DONNELLY BCBA

Provider Business Mailing Address
First Line	:	3000 S ADAMS ST APT 1012
Second Line	:
City	:	TALLAHASSEE
State	:	FL
Zip	:	32301-6946
Country	:	US
Telephone Number	:	252-424-9148
Fax Number	:

Provider Business Practice Location Address
First Line	:	132D CAPE HENRY RD APT D
Second Line	:
City	:	VIRGINIA BEACH
State	:	VA
Zip	:	23451-8093
Country	:	US
Telephone Number	:	252-424-9148
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2022
Last Update Date	:	05/21/2026

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