Healthcare Provider Details

I. General information

NPI: 1366246266
Provider Name (Legal Business Name): SHERICKA HUTCHINSON
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/02/2025
Last Update Date: 04/02/2025
Certification Date: 04/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

757 JENKS AVE
PANAMA CITY FL
32401-2529
US

IV. Provider business mailing address

1715 LOUISIANA AVE
PANAMA CITY FL
32405-5441
US

V. Phone/Fax

Practice location:
  • Phone: 850-270-8411
  • Fax:
Mailing address:
  • Phone: 850-628-5678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License NumberRBT-25-0391-868789
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: