Healthcare Provider Details

I. General information

NPI: 1073442414
Provider Name (Legal Business Name): JASMYN HUTSON RBT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/13/2026
Last Update Date: 05/13/2026
Certification Date: 05/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 HOSPITAL DR
CRESTVIEW FL
32539-7380
US

IV. Provider business mailing address

80 HARRINGTON ST
CRESTVIEW FL
32539-8696
US

V. Phone/Fax

Practice location:
  • Phone: 850-400-6098
  • Fax: 866-265-8817
Mailing address:
  • Phone: 850-400-6098
  • Fax: 866-265-8817

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-536899
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: