MEDICARE: KELLY ARNDT

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	106S00000X	Behavior Technician
2	103K00000X	Behavior Analyst

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1861982563
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY ARNDT

Provider Business Mailing Address
First Line	:	775 AUTUMN ST SE
Second Line	:
City	:	PALM BAY
State	:	FL
Zip	:	32909-4904
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	1887 SE PORT ST LUCIE BLVD
Second Line	:
City	:	PORT SAINT LUCIE
State	:	FL
Zip	:	34952-5530
Country	:	US
Telephone Number	:	772-463-0444
Fax Number	:	772-219-1339

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

Provider Enumeration Date	:	05/17/2018
Last Update Date	:	07/25/2023

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Directions to “ KELLY ARNDT ” Practice Location

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