MEDICARE: KRISTINA OSBORNE MS, BCBA

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1306142625
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTINA OSBORNE MS, BCBA

Provider Business Mailing Address
First Line	:	2850 W HORIZON RIDGE PKWY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4395
Country	:	US
Telephone Number	:	702-610-2076
Fax Number	:	702-527-6907

Provider Business Practice Location Address
First Line	:	2850 W HORIZON RIDGE PKWY
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89052-4395
Country	:	US
Telephone Number	:	702-610-2076
Fax Number	:	702-527-6907

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

Provider Enumeration Date	:	02/03/2011
Last Update Date	:	01/03/2016

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