Healthcare Provider Details

I. General information

NPI: 1710811567
Provider Name (Legal Business Name): JESSIE JUENE CROWDER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8317 FRONT BEACH RD
PANAMA CITY BEACH FL
32407-4885
US

IV. Provider business mailing address

400 CROSSINGS DR
PANAMA CITY BEACH FL
32413-2892
US

V. Phone/Fax

Practice location:
  • Phone: 850-890-3994
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: