Healthcare Provider Details

I. General information

NPI: 1356931018
Provider Name (Legal Business Name): KIMBERLY KAYSER BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/26/2021
Last Update Date: 09/25/2024
Certification Date: 09/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 MAXWELL AVE
EVANSVILLE IN
47711-4363
US

IV. Provider business mailing address

7901 E 88TH ST
INDIANAPOLIS IN
46256-1235
US

V. Phone/Fax

Practice location:
  • Phone: 812-909-9420
  • Fax: 317-842-5911
Mailing address:
  • Phone: 317-849-5437
  • Fax: 317-842-5911

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-24-748888
License Number StateCO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: