Healthcare Provider Details

I. General information

NPI: 1396671335
Provider Name (Legal Business Name): KRISTA RIPLEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/18/2026
Last Update Date: 06/18/2026
Certification Date: 06/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 RICKEY AVE
FORT WALTON BEACH FL
32547-2520
US

IV. Provider business mailing address

601 BLACKSTONE RD
MARY ESTHER FL
32569-1712
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-26-546664
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: