Healthcare Provider Details

I. General information

NPI: 1871419556
Provider Name (Legal Business Name): ALEXANDRIA KAITLYN REGUETT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2026
Last Update Date: 06/26/2026
Certification Date: 06/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

732 WILD HERON WAY
PANAMA CITY BEACH FL
32413-8447
US

IV. Provider business mailing address

732 WILD HERON WAY
PANAMA CITY BEACH FL
32413-8447
US

V. Phone/Fax

Practice location:
  • Phone: 850-213-4595
  • Fax: 850-213-4596
Mailing address:
  • Phone: 850-213-4595
  • Fax: 850-213-4596

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-26-547346
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: