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NPI Code Detail

MEDICARE: KELLY CONLAN BCBA

MEDICARE: KELLY CONLAN 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 Analyst1-05-2178FL

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 : 1881821395
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELLY CONLAN BCBA
Provider Business Mailing Address
First Line : 1591 RUCKEL DR
Second Line :
City : NICEVILLE
State : FL
Zip : 32578-1605
Country : US
Telephone Number : 850-420-1284
Fax Number :
Provider Business Practice Location Address
First Line : 80 COLLEGE BLVD E
Second Line :
City : NICEVILLE
State : FL
Zip : 32578-1343
Country : US
Telephone Number : 850-279-3000
Fax Number : 850-389-2269
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/11/2009
Last Update Date : 08/28/2023

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Directions to “ KELLY CONLAN BCBA” Practice Location

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