Healthcare Provider Details

I. General information

NPI: 1063331528
Provider Name (Legal Business Name): REAGAN BYERS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/10/2026
Last Update Date: 07/10/2026
Certification Date: 07/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 RICKEY AVE # C
FORT WALTON BEACH FL
32547-2520
US

IV. Provider business mailing address

1900 ELEVATE AVE APT G201
NAVARRE FL
32566-6971
US

V. Phone/Fax

Practice location:
  • Phone: 850-376-5624
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-2828857
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: