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General NPI Number Information
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NPI Number | 1073407441
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Entity Type | Individual
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Provider Name | ANTOINE SMYRE PRS
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Gender | Male
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Dates
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Enumeration Date | 06/09/2025
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Last Update Date | 07/09/2025
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Provider Practice Location Address
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Address Line | 521 N ADAMS ST
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City | RICHMOND
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State | VA
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Zip | 23220-3903
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Country | US
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Telephone | 804-940-9445
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Fax |
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Provider Business Mailing Address
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Address Line | 3819 HARROW DR
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City | CHESTER
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State | VA
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Zip | 23831-7146
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Country | US
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Telephone | 804-940-9445
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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 | 175T00000X
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Taxonomy Name | Peer Specialist
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License Number | 0735001300
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License Number State | VA
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