MEDICARE: KIMBERLY TYLER 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	251E00000X	Home Health Agency
2	103K00000X	Behavior Analyst	342	NC

General Provider Information

NPI Number	:	1356403547
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY TYLER BCBA

Provider Business Mailing Address
First Line	:	4921 VISTAWOOD WAY
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27713-8066
Country	:	US
Telephone Number	:	919-602-2292
Fax Number	:

Provider Business Practice Location Address
First Line	:	3001 ACADEMY RD STE 200
Second Line	:
City	:	DURHAM
State	:	NC
Zip	:	27707-6245
Country	:	US
Telephone Number	:	919-602-2292
Fax Number	:

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

Provider Enumeration Date	:	12/14/2006
Last Update Date	:	02/06/2026

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