MEDICARE: KYNADIE BROOKE ADKINS BCBA, LBA

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	9969	TX

General Provider Information

NPI Number	:	1780364612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYNADIE BROOKE ADKINS BCBA, LBA

Provider Business Mailing Address
First Line	:	1312 79TH ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79423-2760
Country	:	US
Telephone Number	:	432-556-0456
Fax Number	:

Provider Business Practice Location Address
First Line	:	5815 82ND ST
Second Line	:
City	:	LUBBOCK
State	:	TX
Zip	:	79424-3654
Country	:	US
Telephone Number	:	806-705-5888
Fax Number	:

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

Provider Enumeration Date	:	07/25/2023
Last Update Date	:	03/19/2026

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