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Kelly John Shover

Behavior Technician in Fairbanks, AK. Individual provider (NPI-1).

NPI number1619720232
StatusActive
Last updated in NPPESApr 11, 2024

Details

NPI
1619720232
Entity type
Individual (NPI-1)
Name
Kelly John Shover
Sex
Male
Sole proprietor
No
Enumeration date
Apr 11, 2024
Certification date
Apr 11, 2024
Last updated
Apr 11, 2024

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
106S00000X Behavior Technician––Yes

Practice location

1521 Hilton Ave
Fairbanks, AK 99701-4015

Phone 907-371-1300

Mailing address

4020 Folker St
Anchorage, AK 99508-5386

Phone 907-563-1000

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