Healthcare Provider Details

I. General information

NPI: 1639901978
Provider Name (Legal Business Name): KADIAN L JAMES
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2024
Last Update Date: 08/15/2024
Certification Date: 08/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5500 MURELL ROAD
MELBOURNE FL
32940
US

IV. Provider business mailing address

7500 SAN FELIPE ST. SUITE 990
HOUSTON TX
77063
US

V. Phone/Fax

Practice location:
  • Phone: 321-426-7759
  • Fax:
Mailing address:
  • Phone: 866-610-0580
  • Fax: 866-611-1558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: