Healthcare Provider Details

I. General information

NPI: 1750182416
Provider Name (Legal Business Name): JERIKA LYNN MEFFORD RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/20/2025
Last Update Date: 03/20/2025
Certification Date: 03/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1405 GILLOCK RD
CARROLLTON KY
41008-9511
US

IV. Provider business mailing address

120 GREENBRIAR DR
CARROLLTON KY
41008-8763
US

V. Phone/Fax

Practice location:
  • Phone: 502-696-1696
  • Fax:
Mailing address:
  • Phone: 502-686-1606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberBACB1282726
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: