MEDICARE: KIMBERLY VANESSA CRUZ-CHAVEZ

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	106S00000X	Behavior Technician		AR

General Provider Information

NPI Number	:	1225985450
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY VANESSA CRUZ-CHAVEZ

Provider Business Mailing Address
First Line	:	2516 N HILLS BLVD
Second Line	:
City	:	VAN BUREN
State	:	AR
Zip	:	72956-6599
Country	:	US
Telephone Number	:	479-235-7443
Fax Number	:

Provider Business Practice Location Address
First Line	:	5704 EUPER LN
Second Line	:
City	:	FORT SMITH
State	:	AR
Zip	:	72903-3238
Country	:	US
Telephone Number	:	479-242-4480
Fax Number	:

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

Provider Enumeration Date	:	03/16/2026
Last Update Date	:	03/16/2026

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Directions to “ KIMBERLY VANESSA CRUZ-CHAVEZ ” Practice Location

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