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1871092247 NPI number — KAYLEE DETWEILER

NPI Number: 1871092247
Health Care Provider/Practitioner: KAYLEE DETWEILER

Information about “1871092247” NPI (KAYLEE DETWEILER) exists in 1871092247 in HTML format HTML  |  1871092247 in plain Text format TXT  |  1871092247 in PDF (Portable Document Format) PDF  |  1871092247 in an XML format XML  formats.

NPI Number : 1871092247 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1871092247",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "Y",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "DETWEILER",
    "FirstName": "KAYLEE",
    "MiddleName": null,
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": null,
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "1500 DOUGLAS ROAD",
    "SecondLineMailingAddress": "STE 230",
    "MailingAddressCityName": "CORAL GABLES",
    "MailingAddressStateName": "FL",
    "MailingAddressPostalCode": "33134",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "844-244-1818",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "5020 GUNN HWY STE 250",
    "SecondLinePracticeLocationAddress": null,
    "PracticeLocationAddressCityName": "TAMPA",
    "PracticeLocationAddressStateName": "FL",
    "PracticeLocationAddressPostalCode": "33624-6361",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "813-733-8572",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "02/12/2018",
    "LastUpdateDate": "09/01/2025",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "F",
    "Gender": "Female",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "106E00000X",
          "TaxonomyName": "Assistant Behavior Analyst",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "106S00000X",
          "TaxonomyName": "Behavior Technician",
          "LicenseNumber": null,
          "LicenseNumberStateCode": null,
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "103K00000X",
          "TaxonomyName": "Behavior Analyst",
          "LicenseNumber": "12365982",
          "LicenseNumberStateCode": "FL",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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