MEDICARE: KRISTIN DEAN (EMPLOYEE ID: 4592260) DEAN

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	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1083566517
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN DEAN (EMPLOYEE ID: 4592260) DEAN

Provider Business Mailing Address
First Line	:	3993 MEMORIAL BLVD
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-4200
Country	:	US
Telephone Number	:	615-203-0900
Fax Number	:	615-203-0900

Provider Business Practice Location Address
First Line	:	3993 MEMORIAL BLVD
Second Line	:
City	:	SPRINGFIELD
State	:	TN
Zip	:	37172-4200
Country	:	US
Telephone Number	:	615-203-0900
Fax Number	:	615-203-0900

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

Provider Enumeration Date	:	02/09/2026
Last Update Date	:	02/09/2026

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