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NPI Code Detail

MEDICARE: KELCEE REBECCA FITZGERALD

MEDICARE:   KELCEE REBECCA FITZGERALD
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
1106S00000XBehavior TechnicianRBT-24-377483FL

General Provider Information

NPI Number : 1295562288
Entity Type Code : Individual
Provider Name (Legal Business Name) : KELCEE REBECCA FITZGERALD
Provider Business Mailing Address
First Line : 1000 PATRIOT LN APT 326
Second Line :
City : CRESTVIEW
State : FL
Zip : 32539-7405
Country : US
Telephone Number : 601-851-6808
Fax Number :
Provider Business Practice Location Address
First Line : 1001 INDUSTRIAL DR # ANA
Second Line :
City : CRESTVIEW
State : FL
Zip : 32539-6943
Country : US
Telephone Number : 850-400-6098
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2024
Last Update Date : 09/16/2024

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Directions to “ KELCEE REBECCA FITZGERALD ” Practice Location

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