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NPI Code Detail

MEDICARE: KIZZY PATTERSON

MEDICARE:   KIZZY  PATTERSON
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 TechnicianFL

General Provider Information

NPI Number : 1548779630
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIZZY PATTERSON
Provider Business Mailing Address
First Line : 6101 HARVEY ST APT 3
Second Line :
City : PANAMA CITY
State : FL
Zip : 32404-7549
Country : US
Telephone Number : 850-541-8991
Fax Number :
Provider Business Practice Location Address
First Line : 1137 HARRISON AVE STE 13A
Second Line :
City : PANAMA CITY
State : FL
Zip : 32401-2498
Country : US
Telephone Number : 850-778-2233
Fax Number : 850-778-2233
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/21/2017
Last Update Date : 09/21/2017

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Directions to “ KIZZY PATTERSON ” Practice Location

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