Healthcare Provider Details

I. General information

NPI: 1801314182
Provider Name (Legal Business Name): KASEY SMITH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/06/2017
Last Update Date: 09/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 GULF BREEZE PKWY
GULF BREEZE FL
32563-3350
US

IV. Provider business mailing address

6897 W CHARLESTON BLVD
LAS VEGAS NV
89117-1640
US

V. Phone/Fax

Practice location:
  • Phone: 800-676-5130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: