Individual
KERRIE RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
14732 OLD SPIKES RD, PANAMA CITY, FL 32409-4637
(850) 867-2009
Mailing address
14732 OLD SPIKES RD, PANAMA CITY, FL 32409-4637
(850) 867-2009
Taxonomy
Speciality
Code
Description
License number
State
106E00000X
Assistant Behavior Analyst
Primary
106E00000X
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
017422400
—
FL
Enumeration date
02/26/2017
Last updated
02/26/2017
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