Healthcare Provider Details

I. General information

NPI: 1346130226
Provider Name (Legal Business Name): MIKELL HUKILL
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/03/2025
Last Update Date: 07/03/2025
Certification Date: 07/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7277 HAWKINS VIEW DR
FORT WORTH TX
76132-3921
US

IV. Provider business mailing address

7277 HAWKINS VIEW DR
FORT WORTH TX
76132-3921
US

V. Phone/Fax

Practice location:
  • Phone: 682-291-9911
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-427052
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: