MEDICARE: JESSICA K ANDREWS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst	1095720	FL

General Provider Information

NPI Number	:	1235465295
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JESSICA K ANDREWS

Provider Business Mailing Address
First Line	:	4750 COLLEGIATE DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-1000
Country	:	US
Telephone Number	:	850-770-2241
Fax Number	:	850-770-2082

Provider Business Practice Location Address
First Line	:	4750 COLLEGIATE DR
Second Line	:
City	:	PANAMA CITY
State	:	FL
Zip	:	32405-1000
Country	:	US
Telephone Number	:	850-770-2241
Fax Number	:	850-770-2082

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/27/2009
Last Update Date	:	10/27/2009

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