Healthcare Provider Details

I. General information

NPI: 1801274832
Provider Name (Legal Business Name): KRISTEN DRURY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2015
Last Update Date: 10/18/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12276 SAN JOSE BLVD STE 508
JACKSONVILLE FL
32223-8628
US

IV. Provider business mailing address

12276 SAN JOSE BLVD STE 508
JACKSONVILLE FL
32223-8628
US

V. Phone/Fax

Practice location:
  • Phone: 904-886-3228
  • Fax: 904-886-3297
Mailing address:
  • Phone: 904-886-3228
  • Fax: 904-886-3297

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: