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NPI Code Detail

MEDICARE: AUDRIANNA NICOLE KING M.A, BCBA

MEDICARE: AUDRIANNA NICOLE KING M.A, BCBA
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 Analyst

General Provider Information

NPI Number : 1730812553
Entity Type Code : Individual
Provider Name (Legal Business Name) : AUDRIANNA NICOLE KING M.A, BCBA
Provider Business Mailing Address
First Line : 3724 KNICKERBOCKER PL APT 2C
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46240-2196
Country : US
Telephone Number : 317-315-7001
Fax Number :
Provider Business Practice Location Address
First Line : 5125 DECATUR BLVD STE A
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46241-7511
Country : US
Telephone Number : 317-315-7001
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/08/2022
Last Update Date : 07/08/2022

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