MEDICARE: KELSEE RAWSON BCABA

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	0134000527	VA
2	103K00000X	Behavior Analyst	52	TN

General Provider Information

NPI Number	:	1851165922
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELSEE RAWSON BCABA

Provider Business Mailing Address
First Line	:	1135 VOLUNTEER PKWY STE 9
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-4658
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1135 VOLUNTEER PKWY STE 9
Second Line	:
City	:	BRISTOL
State	:	TN
Zip	:	37620-4658
Country	:	US
Telephone Number	:	423-652-0174
Fax Number	:

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

Provider Enumeration Date	:	11/09/2023
Last Update Date	:	11/09/2023

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Directions to “ KELSEE RAWSON BCABA” Practice Location

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