NPIMap

Individual provider Active NPI

Kristine Khue Phan

  • Behavior Analyst
  • Hickory, NC
National Provider Identifier
1710444039
Registry record updated Jan 16, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Behavior AnalystTaxonomy code 103K00000X
License
3277 Issued in NC
Practice address
16 2ND St NW
Hickory, NC 28601-6105
Phone
(828) 358-0976
Fax
(828) 838-1057
NPI assigned
Feb 22, 2019
Last updated
Jan 16, 2026By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jan 16, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Behavior Analyst 103K00000X NV
Behavior Analyst 103K00000X 3277 NC Primary
Behavior Analyst 103K00000X NU
Behavior Technician 106S00000X NU

Addresses

Primary practice location

16 2ND St NW
Hickory, NC 28601-6105

Mailing address

PO Box 749
Belmont, NC 28012-0749
Phone (714) 710-2539

Other practice location 1

713 W Commonwealth Ave Ste C
Fullerton, CA 92832-1612
Phone (714) 879-4274

Medicare participation

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

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled

State licenses

LicenseStateTypeSpecialty
3277NCMDProfessional Counselor

Practice roles

OrganizationSpecialtyStatusNew patients
Comprehab LLC Behavior Analyst PastSince Sep 3, 2025 Accepting new patients
Complete Rehabilitation and Sports Physical Therapy, PC PastSince Sep 3, 2025 Accepting new patients
Inspira Behavior and Advocacy Specialists Behavior Analyst Past Accepting new patients

Organizations & group practices 3

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1550793600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1768521600000",
    "number": "1710444039",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 749",
            "city": "BELMONT",
            "state": "NC",
            "postal_code": "280120749",
            "telephone_number": "714-710-2539"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "16 2ND ST NW",
            "city": "HICKORY",
            "state": "NC",
            "postal_code": "286016105",
            "telephone_number": "828-358-0976",
            "fax_number": "828-838-1057"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "713 W Commonwealth Ave Ste C",
            "address_purpose": "LOCATION",
            "city": "Fullerton",
            "state": "CA",
            "postal_code": "928321612",
            "country_code": "US",
            "telephone_number": "714-879-4274",
            "fax_number": "714-879-2274",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PHAN",
        "first_name": "KRISTINE",
        "middle_name": "KHUE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2019-02-22",
        "last_updated": "2026-01-16",
        "certification_date": "2026-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NV",
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NC",
            "license": "3277",
            "primary": true
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "106S00000X",
            "taxonomy_group": "",
            "desc": "Behavior Technician",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Hickory, NC

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2026; 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.