Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103K00000X | Behavior Analyst | ||
Y | 103K00000X | Behavior Analyst | 2017-123 | AL |
NPI | 1003196098 |
---|---|
Provider Name | Kaylon Mims Carpenter |
First Address | Owens Cross Roads, AL 35763-9289 |
Second Address | Owens Cross Roads, AL 35763-9289 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/08/2011 |
Last Update Date | 17/03/2018 |