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General NPI Number Information
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NPI Number | 1497394498
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Entity Type | Individual
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Provider Name | KRISTY CLEVELAND
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Gender | Female
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Dates
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Enumeration Date | 12/23/2019
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Last Update Date | 05/02/2022
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Provider Practice Location Address
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Address Line | 600 LAKE HOLLINGSWORTH DR
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City | LAKELAND
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State | FL
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Zip | 33803-2364
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Country | US
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Telephone | 863-665-7300
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Fax |
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Provider Business Mailing Address
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Address Line | 527 EMERALD COVE LOOP
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City | LAKELAND
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State | FL
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Zip | 33813-2753
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Country | US
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Telephone | 863-212-6936
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 106S00000X
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Taxonomy Name | Behavior Technician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 222Q00000X
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Taxonomy Name | Developmental Therapist
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License Number |
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License Number State |
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Legacy Identifiers
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Identifier #1
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Identifier Code | 1831560762
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Identifier Type | MEDICAID
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Identifier State | FL
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Identifier Issuer |
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Identifier #2
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Identifier Code | 105402900
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Identifier Type | MEDICAID
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Identifier State | FL
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Identifier Issuer | Florida Medicaid Provider ID
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | 105402900
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Identifier Type | MEDICAID
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Identifier State | FL
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Identifier Issuer | Florida Medicaid Provider ID
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Identifier #2
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Identifier Code | 1831560762
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Identifier Type | MEDICAID
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Identifier State | FL
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Identifier Issuer |
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