Healthcare Provider Details

I. General information

NPI: 1134054471
Provider Name (Legal Business Name): KAYVREIONNA WHIGUM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/17/2026
Last Update Date: 06/17/2026
Certification Date: 05/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5250 E US HIGHWAY 36 STE 360
AVON IN
46123-9151
US

IV. Provider business mailing address

7155 ROSSDALE PL
INDIANAPOLIS IN
46241-9591
US

V. Phone/Fax

Practice location:
  • Phone: 317-661-1905
  • Fax: 317-754-2877
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-537387
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: