1659793198 NPI number — MS. KELLY JEAN HILD M.ED, BCBA

Table of content: MS. KELLY JEAN HILD M.ED, BCBA (NPI 1659793198)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659793198 NPI number — MS. KELLY JEAN HILD M.ED, BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
HILD
Provider First Name:
KELLY
Provider Middle Name:
JEAN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
M.ED, BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MATTHEWS
Provider Other First Name:
KELLY
Provider Other Middle Name:
JEAN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1659793198
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 602
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
KASILOF
Provider Business Mailing Address State Name:
AK
Provider Business Mailing Address Postal Code:
99610-0602
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-652-5520
Provider Business Mailing Address Fax Number:
860-652-5520

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 602
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
KASILOF
Provider Business Practice Location Address State Name:
AK
Provider Business Practice Location Address Postal Code:
99610-0602
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-652-5520
Provider Business Practice Location Address Fax Number:
860-652-5520
Provider Enumeration Date:
01/17/2014

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  130138 , registered in the state of AK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com