Healthcare Provider Details

I. General information

NPI: 1972106672
Provider Name (Legal Business Name): CIERRA CASEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CIERRA SMITH

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 03/16/2026
Certification Date: 03/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2701 ALBRIGHT RD
KOKOMO IN
46902-3996
US

IV. Provider business mailing address

2701 ALBRIGHT RD
KOKOMO IN
46902-3996
US

V. Phone/Fax

Practice location:
  • Phone: 765-432-7107
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-25-84630
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: