Healthcare Provider Details

I. General information

NPI: 1306759451
Provider Name (Legal Business Name): KELLIE GENE CROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/28/2026
Last Update Date: 09/28/2026
Certification Date: 09/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

907 OUTER RD STE B
ORLANDO FL
32814-6601
US

IV. Provider business mailing address

250 CAROLINA AVE APT 207
WINTER PARK FL
32789-6406
US

V. Phone/Fax

Practice location:
  • Phone: 407-217-1401
  • Fax:
Mailing address:
  • Phone: 407-739-1488
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106E00000X
TaxonomyAssistant Behavior Analyst
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: