1699929547 NPI number — MS. KIMBERLY ANN BRAY BCBA

Table of content: (NPI 1437316700)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1699929547 NPI number — MS. KIMBERLY ANN BRAY BCBA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BRAY
Provider First Name:
KIMBERLY
Provider Middle Name:
ANN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
BCBA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1699929547
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/05/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 1759
Provider Second Line Business Mailing Address:
DEPT. 952
Provider Business Mailing Address City Name:
HOUSTON
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77251-1759
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-554-5304
Provider Business Mailing Address Fax Number:
713-554-5320

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2075 MEADOWLANE AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WEST MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32904-4951
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-724-4482
Provider Business Practice Location Address Fax Number:
321-757-5177
Provider Enumeration Date:
11/05/2008

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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