Healthcare Provider Details

I. General information

NPI: 1780268375
Provider Name (Legal Business Name): BERNICE KYLA NACINO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2021
Last Update Date: 01/15/2024
Certification Date: 01/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3552 FM 1092 RD
MISSOURI CITY TX
77459-2203
US

IV. Provider business mailing address

6206 PRESIDIO CANYON DR
KATY TX
77450-8756
US

V. Phone/Fax

Practice location:
  • Phone: 346-368-4412
  • Fax:
Mailing address:
  • Phone: 713-291-4997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number1873963
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-23-69948
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: