Healthcare Provider Details

I. General information

NPI: 1417610734
Provider Name (Legal Business Name): KATHLEEN JILL BYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KATHLEEN JILL WELLING

II. Dates (important events)

Enumeration Date: 10/14/2021
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11902 LAKESIDE DR
FISHERS IN
46038-1308
US

IV. Provider business mailing address

2550 N HOLLYWOOD WAY STE 102
BURBANK CA
91505-5031
US

V. Phone/Fax

Practice location:
  • Phone: 317-288-5232
  • Fax:
Mailing address:
  • Phone: 866-727-8274
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: