MEDICARE: KAYLON WARREN

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	103K00000X	Behavior Analyst

General Provider Information

NPI Number	:	1720400914
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KAYLON WARREN

Provider Business Mailing Address
First Line	:	5913 HILMONT ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1729
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5913 HILMONT ST
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89031-1729
Country	:	US
Telephone Number	:	702-439-5383
Fax Number	:

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

Provider Enumeration Date	:	01/08/2014
Last Update Date	:	01/08/2014

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