MEDICARE: KATRINA SHIRTAY GIVENS

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	22648516	NC

General Provider Information

NPI Number	:	1689550808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KATRINA SHIRTAY GIVENS

Provider Business Mailing Address
First Line	:	1108 GLENFIDDICH DR APT H
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-2082
Country	:	US
Telephone Number	:	704-967-5228
Fax Number	:	704-967-5228

Provider Business Practice Location Address
First Line	:	1108 GLENFIDDICH DR APT H
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28215-2082
Country	:	US
Telephone Number	:	704-967-5228
Fax Number	:	704-967-5228

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

Provider Enumeration Date	:	08/13/2025
Last Update Date	:	08/13/2025

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Directions to “ KATRINA SHIRTAY GIVENS ” Practice Location

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