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General NPI Number Information
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NPI Number | 1023284213
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Entity Type | Individual
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Provider Name | KYLE ANDERSON KELLY M.D.
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Gender | Male
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 03/06/2025
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Provider Practice Location Address
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Address Line | 1551 E TANGERINE RD
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City | ORO VALLEY
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State | AZ
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Zip | 85755-6213
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Country | US
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Telephone | 520-901-3500
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 841656
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City | DALLAS
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State | TX
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Zip | 75284-1656
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Country | US
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Telephone | 903-531-5000
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | N9575
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 75449
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License Number State | AZ
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