Provider Demographics
NPI:1235646258
Name:PUCKETT, ALICIA ANN (RBT)
Entity Type:Individual
Prefix:MRS
First Name:ALICIA
Middle Name:ANN
Last Name:PUCKETT
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:ALICIA
Other - Middle Name:A
Other - Last Name:WEST
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:1109 PAWNEE DR
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2019
Mailing Address - Country:US
Mailing Address - Phone:502-705-4221
Mailing Address - Fax:
Practice Address - Street 1:1109 PAWNEE DR
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2019
Practice Address - Country:US
Practice Address - Phone:502-705-4221
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-12-29
Last Update Date:2022-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYRBT-16-25713106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician