Healthcare Provider Details

I. General information

NPI: 1346823044
Provider Name (Legal Business Name): KAITLYN SIMON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/30/2021
Last Update Date: 08/02/2026
Certification Date: 08/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9025 NOVANT HEALTH PY STE 100
CHARLOTTE NC
28215-0098
US

IV. Provider business mailing address

8665 WATERLYNN CIR NW APT 308
CONCORD NC
28027-0034
US

V. Phone/Fax

Practice location:
  • Phone: 980-785-1113
  • Fax:
Mailing address:
  • Phone: 719-588-1660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-69711
License Number StateUT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: