Provider Demographics
NPI:1982420733
Name:DARTY, KAYLEE NICCOLE
Entity type:Individual
Prefix:
First Name:KAYLEE
Middle Name:NICCOLE
Last Name:DARTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:244 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:AL
Mailing Address - Zip Code:35634-6441
Mailing Address - Country:US
Mailing Address - Phone:256-443-8205
Mailing Address - Fax:
Practice Address - Street 1:204 W TUSCALOOSA ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-5428
Practice Address - Country:US
Practice Address - Phone:256-202-4885
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-11-26
Last Update Date:2024-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-7821103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst