Healthcare Provider Details

I. General information

NPI: 1427377290
Provider Name (Legal Business Name): NICOLE M CARLISLE BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/19/2010
Last Update Date: 03/02/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10621 RENE ST
LENEXA KS
66215-4052
US

IV. Provider business mailing address

10621 RENE ST
LENEXA KS
66215-4052
US

V. Phone/Fax

Practice location:
  • Phone: 913-825-0893
  • Fax: 913-825-0896
Mailing address:
  • Phone: 913-825-0893
  • Fax: 913-825-0896

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: