MEDICARE: MS. KRISTINE KAISER CRAVENER BS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320900000X	Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility		FL
2	106S00000X	Behavior Technician	RBT-25-452047	FL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1063020188
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. KRISTINE KAISER CRAVENER BS

Provider Business Mailing Address
First Line	:	1095 BECKMAN DR
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-2499
Country	:	US
Telephone Number	:	386-566-0444
Fax Number	:

Provider Business Practice Location Address
First Line	:	1095 BECKMAN DR
Second Line	:
City	:	SOUTH DAYTONA
State	:	FL
Zip	:	32119-2499
Country	:	US
Telephone Number	:	386-566-0444
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/14/2020
Last Update Date	:	03/02/2026

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