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NPI Code Detail

MEDICARE: KIMBERLY JAMISON RBT

MEDICARE: KIMBERLY JAMISON RBT
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
1106E00000XAssistant Behavior AnalystRBT1855274LA

General Provider Information

NPI Number : 1588237176
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY JAMISON RBT
Provider Business Mailing Address
First Line : 10450 ELLERBE RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71106-7730
Country : US
Telephone Number : 318-629-1732
Fax Number : 318-629-2735
Provider Business Practice Location Address
First Line : 10450 ELLERBE RD
Second Line :
City : SHREVEPORT
State : LA
Zip : 71106-7730
Country : US
Telephone Number : 318-629-1732
Fax Number : 318-629-2735
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/21/2021
Last Update Date : 07/21/2021

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Directions to “ KIMBERLY JAMISON RBT” Practice Location

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