Kirstan Iyanna Mickens

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

RBT-23-304864 Issued in FL

Practice address

7301A W Palmetto Park Rd Ste 100C
Boca Raton, FL 33433-3403

Phone

(954) 248-1171

NPI assigned

Jan 22, 2024

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Mindful Sprouts LLC

  • Behavior Analyst
  • Boca Raton, FL
  • NPI 1326505751
  NPD
• Mindful Sprouts LLC

  • Speech-Language Pathologist
  • Boca Raton, FL
  • NPI 1538933171
  NPD

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

{
    "created_epoch": "1705881600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705881600000",
    "number": "1720849375",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2419 24TH LN",
            "city": "GREENACRES",
            "state": "FL",
            "postal_code": "334634263"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "7301A W PALMETTO PARK RD STE 100C",
            "city": "BOCA RATON",
            "state": "FL",
            "postal_code": "334333403",
            "telephone_number": "954-248-1171"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MICKENS",
        "first_name": "KIRSTAN",
        "middle_name": "IYANNA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-22",
        "last_updated": "2024-01-22",
        "certification_date": "2024-01-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "FL",
            "license": "RBT-23-304864",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michele E. Willey D.O. P.a.
• Michele J. Moraes, MD PA
• Michelle Mankoff, Inc
• Michelle Y Bruzzo MD PA
• Margot B Michelman, M.A. C.C.C. SLP
• Microsurgery Inc.
• Mid Florida Anesthesia Associates, Inc.
• Mid-Florida Anesthesia Associates
• Kristen Middleton
• Bethe Midler, RBT

• Behavior Analyst in Boca Raton, FL
• Providers in Boca Raton, FL by specialty
• Behavior Analyst in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 22, 2024; 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.