Healthcare Provider Details

I. General information

NPI: 1013835727
Provider Name (Legal Business Name): KRISTEN MCGILL
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

1984 MADISON AVE
MELBOURNE FL
32935-4048
US

IV. Provider business mailing address

326 CROTON RD
MELBOURNE FL
32935-6340
US

V. Phone/Fax

Practice location:
  • Phone: 321-508-2675
  • Fax: 208-210-3968
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2828047
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: