MEDICARE: KYLEE CORKEN M.A., BCBA - LBA

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
2	103K00000X	Behavior Analyst	1-17-28867	OK

General Provider Information

NPI Number	:	1306352737
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLEE CORKEN M.A., BCBA - LBA

Provider Business Mailing Address
First Line	:	1022 JONES RD
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-0705
Country	:	US
Telephone Number	:	479-318-2300
Fax Number	:

Provider Business Practice Location Address
First Line	:	1022 JONES RD
Second Line	:
City	:	SPRINGDALE
State	:	AR
Zip	:	72762-0705
Country	:	US
Telephone Number	:	479-318-2300
Fax Number	:

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

Provider Enumeration Date	:	12/21/2017
Last Update Date	:	10/13/2022

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