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NPI Code Detail

MEDICARE: BETHANY KIMMEL

MEDICARE: BETHANY KIMMEL
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 : 1790564904
Entity Type Code : Individual
Provider Name (Legal Business Name) : BETHANY KIMMEL
Provider Business Mailing Address
First Line : 504 NOBLE CT
Second Line :
City : GUYTON
State : GA
Zip : 31312-5827
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 100 COMMERCE CT
Second Line :
City : POOLER
State : GA
Zip : 31322-9445
Country : US
Telephone Number : 615-560-6622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/26/2023
Last Update Date : 09/26/2023

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Directions to “ BETHANY KIMMEL ” Practice Location

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