Healthcare Provider Details

I. General information

NPI: 1912860578
Provider Name (Legal Business Name): KIANNA HESLOP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/09/2025
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1806 SE INDIAN ST
STUART FL
34997-4919
US

IV. Provider business mailing address

8753 WATERSTONE BLVD
FORT PIERCE FL
34951-1604
US

V. Phone/Fax

Practice location:
  • Phone: 772-266-8727
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-489633
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: