Krizia Kiziswa Burke-Forde

Primary specialty

Behavior TechnicianTaxonomy code 106S00000X

License

RBT-22-204080 Issued in FL

Practice address

12501 World Plaza LN BLDG 51
Fort Myers, FL 33907-3991

Phone

(239) 349-3139

Fax

(239) 984-4372

NPI assigned

Feb 9, 2022

Sex

Female

Sole proprietor

No

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Autism Services of FL

  • Behavior Analyst
  • Fort Myers, FL
  • NPI 1801471081
  NPD

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Sep 12, 2023.

{
    "created_epoch": "1644364800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1694476800000",
    "number": "1104570050",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12438 BRANTLEY COMMONS CT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339075683",
            "telephone_number": "239-349-3139",
            "fax_number": "239-984-4372"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "12501 WORLD PLAZA LN BLDG 51",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339073991",
            "telephone_number": "239-349-3139",
            "fax_number": "239-984-4372"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BURKE-FORDE",
        "first_name": "KRIZIA",
        "middle_name": "KIZISWA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-09",
        "last_updated": "2023-09-12",
        "certification_date": "2023-09-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "FL",
            "license": "RBT-22-204080",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Carrie Burgess
• Kaylee Burgess
• Richard Burgess
• Kenadee Burgoyne
• Peggy Burk, CRNA
• Brandi Leigh Burke, LCSW
• Celia M Burke
• James H Burks, MD
• Raina Burlak, MS NCC
• Corinne Burley, CRNA

• All providers in Fort Myers, FL
• Behavior Technician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 12, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.