Healthcare Provider Details

I. General information

NPI: 1114648193
Provider Name (Legal Business Name): MELISSA KINSEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/07/2022
Last Update Date: 04/08/2026
Certification Date: 04/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13 E MELBOURNE AVE STE D
MELBOURNE FL
32901-5976
US

IV. Provider business mailing address

13 E MELBOURNE AVE STE D
MELBOURNE FL
32901-5976
US

V. Phone/Fax

Practice location:
  • Phone: 321-888-3438
  • Fax: 321-225-6772
Mailing address:
  • Phone: 321-888-3438
  • Fax: 321-225-6772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-88708
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: