Provider Demographics
NPI:1508174533
Name:BELL, KRISTY L (BCBA)
Entity Type:Individual
Prefix:
First Name:KRISTY
Middle Name:L
Last Name:BELL
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11451 KABROON CT
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32246-6920
Mailing Address - Country:US
Mailing Address - Phone:904-343-0521
Mailing Address - Fax:
Practice Address - Street 1:4123 UNIVERSITY BLVD S
Practice Address - Street 2:SUITE C
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-4371
Practice Address - Country:US
Practice Address - Phone:904-329-3317
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-24
Last Update Date:2020-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
FL0-05-1696103K00000X
FL1-17-25645103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst