MEDICARE: KAITLYNN RENEE MCMULLEN

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

General Provider Information

NPI Number	:	1528887064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAITLYNN RENEE MCMULLEN

Provider Business Mailing Address
First Line	:	2603 BAYCREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3705
Country	:	US
Telephone Number	:	907-726-3167
Fax Number	:

Provider Business Practice Location Address
First Line	:	2603 BAYCREST DR
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77058-3705
Country	:	US
Telephone Number	:	907-726-3167
Fax Number	:

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

Provider Enumeration Date	:	10/10/2024
Last Update Date	:	10/10/2024

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