Provider Demographics
NPI:1851012108
Name:WILKERSON, KEVYNNE BRIANNE (RBT)
Entity Type:Individual
Prefix:
First Name:KEVYNNE
Middle Name:BRIANNE
Last Name:WILKERSON
Suffix:
Gender:F
Credentials:RBT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8162 OWL CLAN CT
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89131-1437
Mailing Address - Country:US
Mailing Address - Phone:702-762-1061
Mailing Address - Fax:
Practice Address - Street 1:7061 W ARBY AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89113-4452
Practice Address - Country:US
Practice Address - Phone:702-813-3437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-09-06
Last Update Date:2022-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVRBT-21-175191106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician