Provider Demographics
NPI:1790571073
Name:BELLEVILLE, KERRI RENE
Entity type:Individual
Prefix:
First Name:KERRI
Middle Name:RENE
Last Name:BELLEVILLE
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1120 JENKS AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32401-2439
Mailing Address - Country:US
Mailing Address - Phone:850-215-6770
Mailing Address - Fax:850-665-0123
Practice Address - Street 1:1120 JENKS AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32401-2439
Practice Address - Country:US
Practice Address - Phone:850-215-6770
Practice Address - Fax:850-665-0123
Is Sole Proprietor?:No
Enumeration Date:2025-04-15
Last Update Date:2025-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician