Healthcare Provider Details

I. General information

NPI: 1235722802
Provider Name (Legal Business Name): KYRA SMALLWOOD BCBA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2021
Last Update Date: 08/14/2026
Certification Date: 08/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

785 FODDERSTACK RIDGE RD
GREENEVILLE TN
37745-2365
US

IV. Provider business mailing address

1543 PICKETT RD
SIGNAL MOUNTAIN TN
37377-7749
US

V. Phone/Fax

Practice location:
  • Phone: 423-381-0777
  • Fax: 423-616-5011
Mailing address:
  • Phone: 615-540-7150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-21-47674
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: