Provider Demographics
NPI:1750957163
Name:NIXON, KIMBERLEY GUILER (BCBA)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:GUILER
Last Name:NIXON
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:KIMBERLEY
Other - Middle Name:MARIE
Other - Last Name:GUILER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2400 STANFORD RD
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-3551
Mailing Address - Country:US
Mailing Address - Phone:334-701-1329
Mailing Address - Fax:
Practice Address - Street 1:4750 COLLEGIATE DR
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-1000
Practice Address - Country:US
Practice Address - Phone:850-770-2241
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-05-27
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
1-24-73676103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician