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NPI Code Detail

MEDICARE: KHENDAL ISLEY ROBINSON

MEDICARE: KHENDAL ISLEY ROBINSON
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 Analyst1-22-61519FL

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 : 1689238834
Entity Type Code : Individual
Provider Name (Legal Business Name) : KHENDAL ISLEY ROBINSON
Provider Business Mailing Address
First Line : 2200 MARSH HAWK LN UNIT 402
Second Line :
City : FLEMING ISLAND
State : FL
Zip : 32003-4313
Country : US
Telephone Number : 904-571-1486
Fax Number :
Provider Business Practice Location Address
First Line : 12735 GRAN BAY PKWY W STE 204
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32258-4499
Country : US
Telephone Number : 888-754-0398
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/23/2019
Last Update Date : 08/21/2023

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