Healthcare Provider Details

I. General information

NPI: 1689287666
Provider Name (Legal Business Name): KIMBERLY HAYE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 11/19/2024
Certification Date: 11/19/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7730 W SAHARA AVE
LAS VEGAS NV
89117-2798
US

IV. Provider business mailing address

6363 S PECOS RD STE 206
LAS VEGAS NV
89120-6293
US

V. Phone/Fax

Practice location:
  • Phone: 702-660-2005
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberLBA0944
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: