Bobbi Nicole Donovan

Individual provider Active NPI Behavior Technician · Gulfport, MS

NPI 1124642434 · NPPES record last updated Jun 2, 2020

Key facts

NPI
1124642434
Entity type
Individual (NPI type 1)
Primary specialty
Behavior Technician 106S00000X
Practice address
9480 Three Rivers Rd
Gulfport, MS 39503-4248
Phone
(251) 648-4346
Fax
(888) 462-6035
NPI assigned
Jun 2, 2020
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Technician 106S00000X Yes

Addresses

Primary practice location

9480 Three Rivers Rd
Gulfport, MS 39503-4248

Mailing address

9480 Three Rivers Rd
Gulfport, MS 39503-4248
Phone (251) 648-4346

Other providers in Gulfport, MS

All providers in Gulfport, MS · Behavior Technician in Mississippi

Sources for this page

Verify at the official NPI Registry.