MEDICARE: KARA FYFFE

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		TN

General Provider Information

NPI Number	:	1255189650
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARA FYFFE

Provider Business Mailing Address
First Line	:	1159 HARRISON PIKE APT 2308
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-5769
Country	:	US
Telephone Number	:	267-853-8407
Fax Number	:

Provider Business Practice Location Address
First Line	:	1159 HARRISON PIKE APT 2308
Second Line	:
City	:	CLEVELAND
State	:	TN
Zip	:	37311-5769
Country	:	US
Telephone Number	:	267-853-8407
Fax Number	:

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

Provider Enumeration Date	:	05/09/2024
Last Update Date	:	05/09/2024

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Directions to “ KARA FYFFE ” Practice Location

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