Healthcare Provider Details

I. General information

NPI: 1871104521
Provider Name (Legal Business Name): KEYANDRE THOMPSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/14/2020
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

644 FERGUSON DR STE 200
ORLANDO FL
32805-1014
US

IV. Provider business mailing address

6120 ECHELON WAY
DAVENPORT FL
33896-9667
US

V. Phone/Fax

Practice location:
  • Phone: 407-574-4629
  • Fax:
Mailing address:
  • Phone: 813-830-2833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-26-89356
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: