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NPI Code Detail

MEDICARE: NICOLE ILENE NUMKENA

MEDICARE: NICOLE ILENE NUMKENA
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 Analyst
2106S00000XBehavior Technician

Other Identifiers

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

General Provider Information

NPI Number : 1932568854
Entity Type Code : Individual
Provider Name (Legal Business Name) : NICOLE ILENE NUMKENA
Provider Business Mailing Address
First Line : 617 SLADE ST
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-3941
Country : US
Telephone Number : 801-649-9011
Fax Number :
Provider Business Practice Location Address
First Line : 506 N MAIN ST
Second Line :
City : HINESVILLE
State : GA
Zip : 31313-2512
Country : US
Telephone Number : 615-560-6622
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2016
Last Update Date : 02/17/2025

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Directions to “ NICOLE ILENE NUMKENA ” Practice Location

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These directions are for planning purposes only. You may find that construction projects, traffic, or other events may cause road conditions to differ from the map results.

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