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NPI Code Detail

MEDICARE: KENDRIC RASHAAD STARLING SR.

MEDICARE: KENDRIC RASHAAD STARLING SR.
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
1103K00000XBehavior Analyst101108319GA

General Provider Information

NPI Number : 1184051476
Entity Type Code : Individual
Provider Name (Legal Business Name) : KENDRIC RASHAAD STARLING SR.
Provider Business Mailing Address
First Line : 5440 GREENLEY GARDENS ST
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89081-4071
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3450 W CHEYENNE AVE STE 500
Second Line :
City : NORTH LAS VEGAS
State : NV
Zip : 89032-8225
Country : US
Telephone Number : 229-834-2977
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2013
Last Update Date : 10/01/2013

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