MEDICARE: KYNIELL RICHARD

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	:	1770869059
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYNIELL RICHARD

Provider Business Mailing Address
First Line	:	2285A RENAISSANCE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6753
Country	:	US
Telephone Number	:	702-207-6782
Fax Number	:	702-207-6791

Provider Business Practice Location Address
First Line	:	2285A RENAISSANCE DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-6753
Country	:	US
Telephone Number	:	702-207-6782
Fax Number	:	702-207-6791

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

Provider Enumeration Date	:	10/31/2011
Last Update Date	:	10/31/2011

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Directions to “ KYNIELL RICHARD ” Practice Location

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