Healthcare Provider Details

I. General information

NPI: 1982508883
Provider Name (Legal Business Name): KRYSTLE ABRIELLE CASTELLANOS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

131 HATCHER LN STE A
CLARKSVILLE TN
37043-5921
US

IV. Provider business mailing address

300 INTERNATIONAL PKWY STE 2
LAKE MARY FL
32746-5035
US

V. Phone/Fax

Practice location:
  • Phone: 931-444-1449
  • Fax: 931-919-1207
Mailing address:
  • Phone: 866-610-0580
  • Fax: 866-611-1558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: