Healthcare Provider Details

I. General information

NPI: 1568002889
Provider Name (Legal Business Name): MICHELLE LEE KINDER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2020
Last Update Date: 01/29/2026
Certification Date: 01/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12123 ROCKFORD ST
SPRING HILL FL
34608-2156
US

IV. Provider business mailing address

12123 ROCKFORD ST
SPRING HILL FL
34608-2156
US

V. Phone/Fax

Practice location:
  • Phone: 352-247-9197
  • Fax:
Mailing address:
  • Phone: 352-247-9197
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-50444
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: