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NPI Code Detail

MEDICARE: MISS KIMBERLY RENEE MARTIN BCBA-D

MEDICARE: MISS KIMBERLY RENEE MARTIN BCBA-D
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
1101YM0800XMental Health Counselor
2103K00000XBehavior AnalystLBA0000000980TN
3103K00000XBehavior AnalystFL

General Provider Information

NPI Number : 1700333416
Entity Type Code : Individual
Provider Name (Legal Business Name) : MISS KIMBERLY RENEE MARTIN BCBA-D
Provider Business Mailing Address
First Line : PO BOX 740780
Second Line :
City : ATLANTA
State : GA
Zip : 30374-0780
Country : US
Telephone Number : 855-223-7123
Fax Number :
Provider Business Practice Location Address
First Line : 108 W 1ST AVE STE C
Second Line :
City : OWASSO
State : OK
Zip : 74055-3137
Country : US
Telephone Number : 855-223-7123
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/10/2016
Last Update Date : 02/10/2026

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Directions to “ MISS KIMBERLY RENEE MARTIN BCBA-D” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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