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General NPI Number Information
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NPI Number | 1073412805
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Entity Type | Individual
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Provider Name | KATE AXON FNP
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Gender | Female
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Dates
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Enumeration Date | 11/05/2026
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Last Update Date | 11/05/2026
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Provider Practice Location Address
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Address Line | 777 NW 9TH ST
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City | CORVALLIS
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State | OR
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Zip | 97330-6169
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Country | US
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Telephone | 541-768-1840
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Fax |
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Provider Business Mailing Address
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Address Line | 2411 NW 11TH ST
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City | CORVALLIS
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State | OR
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Zip | 97330-1420
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Country | US
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Telephone |
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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 | 207QA0505X
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Taxonomy Name | Adult Medicine Physician
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License Number | 10069469
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License Number State | OR
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