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NPI Code Detail

MEDICARE: MRS. KIRSTIE SMITH BCBA

MEDICARE: MRS. KIRSTIE SMITH BCBA
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
1103K00000XBehavior Analyst8986TX

General Provider Information

NPI Number : 1932565587
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIRSTIE SMITH BCBA
Provider Business Mailing Address
First Line : 4534 BRUSHY CREEK CV
Second Line :
City : TYLER
State : TX
Zip : 75703-4057
Country : US
Telephone Number : 870-784-1421
Fax Number :
Provider Business Practice Location Address
First Line : 3310 S BROADWAY AVE STE 100A
Second Line :
City : TYLER
State : TX
Zip : 75701-7818
Country : US
Telephone Number : 903-991-8048
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/13/2016
Last Update Date : 09/12/2025

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Directions to “ MRS. KIRSTIE SMITH BCBA” Practice Location

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