Provider Demographics
NPI:1760823454
Name:FERNAND, JONATHAN KYLE (MA, BCBA)
Entity Type:Individual
Prefix:MR
First Name:JONATHAN
Middle Name:KYLE
Last Name:FERNAND
Suffix:
Gender:M
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:113 NW 3RD AVE
Mailing Address - Street 2:#105
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32601-3236
Mailing Address - Country:US
Mailing Address - Phone:916-601-9248
Mailing Address - Fax:
Practice Address - Street 1:945 CENTER DR
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32611-2250
Practice Address - Country:US
Practice Address - Phone:352-273-2184
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-10
Last Update Date:2013-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1-13-13985103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst