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NPI Code Detail

MEDICARE: MS. KANISHA NICOLE EBERHARDT QASP-S

MEDICARE: MS. KANISHA NICOLE EBERHARDT QASP-S
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
1247200000XOther TechnicianRBT-20-119073GA
2106E00000XAssistant Behavior Analyst11343

General Provider Information

NPI Number : 1548831902
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. KANISHA NICOLE EBERHARDT QASP-S
Provider Business Mailing Address
First Line : 3633 WHEELER RD STE 320
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-6552
Country : US
Telephone Number : 706-842-3279
Fax Number :
Provider Business Practice Location Address
First Line : 3633 WHEELER RD STE 320
Second Line :
City : AUGUSTA
State : GA
Zip : 30909-6552
Country : US
Telephone Number : 706-842-3279
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/07/2021
Last Update Date : 11/07/2023

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