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NPI Code Detail

MEDICARE: KOURTNEY HENDRIX

MEDICARE: KOURTNEY HENDRIX
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
1106S00000XBehavior Technician

General Provider Information

NPI Number : 1750026480
Entity Type Code : Individual
Provider Name (Legal Business Name) : KOURTNEY HENDRIX
Provider Business Mailing Address
First Line : 201 SW VEAL CT
Second Line :
City : PORT SAINT LUCIE
State : FL
Zip : 34953-5923
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 4203 SW HIGH MEADOWS AVE
Second Line :
City : PALM CITY
State : FL
Zip : 34990-3726
Country : US
Telephone Number : 772-222-5560
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/27/2022
Last Update Date : 04/27/2022

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Directions to “ KOURTNEY HENDRIX ” Practice Location

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