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NPI Code Detail

MEDICARE: MIKIA DESHEA COSTON

MEDICARE: MIKIA DESHEA COSTON
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
1106S00000XBehavior TechnicianBACB1296313KY

General Provider Information

NPI Number : 1932055969
Entity Type Code : Individual
Provider Name (Legal Business Name) : MIKIA DESHEA COSTON
Provider Business Mailing Address
First Line : 90 HOWARD DR
Second Line :
City : SHELBYVILLE
State : KY
Zip : 40065-8138
Country : US
Telephone Number : 502-233-9074
Fax Number :
Provider Business Practice Location Address
First Line : 261 RUCCIO WAY STE 190
Second Line :
City : LEXINGTON
State : KY
Zip : 40503-3566
Country : US
Telephone Number : 859-279-0252
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/10/2026
Last Update Date : 03/10/2026

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Directions to “ MIKIA DESHEA COSTON ” Practice Location

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