Healthcare Provider Details

I. General information

NPI: 1669353348
Provider Name (Legal Business Name): KIMBERLY DAVIS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/10/2025
Last Update Date: 03/13/2026
Certification Date: 03/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7971 RIVIERA BLVD STE 402
MIRAMAR FL
33023-6449
US

IV. Provider business mailing address

1477 NW 91ST AVE APT 1213
CORAL SPRINGS FL
33071-6644
US

V. Phone/Fax

Practice location:
  • Phone: 561-337-1193
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-463608
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: