Provider Demographics
NPI:1396217204
Name:APONGAN, KIMBERLY (RBT 18-73617)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:APONGAN
Suffix:
Gender:F
Credentials:RBT 18-73617
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5154 BAYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2102
Mailing Address - Country:US
Mailing Address - Phone:850-416-4681
Mailing Address - Fax:850-416-7776
Practice Address - Street 1:5154 BAYOU BLVD
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2102
Practice Address - Country:US
Practice Address - Phone:850-416-4681
Practice Address - Fax:850-416-7776
Is Sole Proprietor?:No
Enumeration Date:2018-12-18
Last Update Date:2018-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst