Healthcare Provider Details

I. General information

NPI: 1194635565
Provider Name (Legal Business Name): ANGEL EDINGTON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/09/2026
Last Update Date: 09/09/2026
Certification Date: 09/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1950 HAGGARD CT
LEXINGTON KY
40505-1534
US

IV. Provider business mailing address

352 HIGH ST APT 4
RICHMOND KY
40475-1388
US

V. Phone/Fax

Practice location:
  • Phone: 502-777-2397
  • Fax: 502-236-1318
Mailing address:
  • Phone: 502-777-2397
  • Fax: 502-236-1318

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-24-369560
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: