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NPI Code Detail

MEDICARE: CIARA BROOKE HAMPTON KIDWELL

MEDICARE: CIARA BROOKE HAMPTON KIDWELL
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 Analyst

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1366040271
Entity Type Code : Individual
Provider Name (Legal Business Name) : CIARA BROOKE HAMPTON KIDWELL
Provider Business Mailing Address
First Line : 13201 SUGARBLUFF RD
Second Line :
City : CLERMONT
State : FL
Zip : 34715-6819
Country : US
Telephone Number : 352-978-3045
Fax Number :
Provider Business Practice Location Address
First Line : 350 ACCEPTANCE WAY
Second Line :
City : CLERMONT
State : FL
Zip : 34711-2788
Country : US
Telephone Number : 352-978-3045
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/13/2020
Last Update Date : 06/24/2022

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