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NPI Code Detail

MEDICARE: CORY EVERHEART BCBA

MEDICARE: CORY EVERHEART 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
1103K00000XBehavior Analyst1841609047FL

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1841609047
Entity Type Code : Individual
Provider Name (Legal Business Name) : CORY EVERHEART BCBA
Provider Business Mailing Address
First Line : 3825 GARNET DR
Second Line :
City : MULBERRY
State : FL
Zip : 33860-8622
Country : US
Telephone Number : 863-944-3484
Fax Number :
Provider Business Practice Location Address
First Line : 4222 S FLORIDA AVE
Second Line :
City : LAKELAND
State : FL
Zip : 33813-1628
Country : US
Telephone Number : 863-204-6095
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/13/2014
Last Update Date : 05/13/2024

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Directions to “ CORY EVERHEART BCBA” Practice Location

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