MEDICARE: KIYA JAMISON

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	:	1285580480
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIYA JAMISON

Provider Business Mailing Address
First Line	:	8413 CONNER RIDGE LN
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28269-0978
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3820 RANDOLPH HEIGHTS DR STE 100
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28205-7566
Country	:	US
Telephone Number	:	980-819-0010
Fax Number	:

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

Provider Enumeration Date	:	03/09/2026
Last Update Date	:	03/09/2026

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Directions to “ KIYA JAMISON ” Practice Location

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