Healthcare Provider Details

I. General information

NPI: 1245143221
Provider Name (Legal Business Name): ANNIKA DEFINO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: ANNIKA HER

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10209 N MACARTHUR BLVD APT 123
IRVING TX
75063-5334
US

IV. Provider business mailing address

10209 N MACARTHUR BLVD APT 123
IRVING TX
75063-5334
US

V. Phone/Fax

Practice location:
  • Phone: 907-206-0756
  • Fax:
Mailing address:
  • Phone: 907-206-0756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License NumberRBT-25-482637
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: