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General NPI Number Information
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NPI Number | 1083430185
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Entity Type | Organization
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Legal Business Name | KOTEL ATX
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Dates
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Enumeration Date | 11/23/2024
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Last Update Date | 12/07/2024
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Provider Practice Location Address
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Address Line | 4201 W PARMER LN STE C175
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City | AUSTIN
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State | TX
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Zip | 78727-4161
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Country | US
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Telephone | 855-204-2502
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Fax |
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Provider Business Mailing Address
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Address Line | 3001 BEE CAVES RD STE 220
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City | AUSTIN
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State | TX
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Zip | 78746-5590
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Country | US
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Telephone | 512-777-2591
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Fax | 512-777-3193
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Authorized Official
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Title or Position | CREDENTIALING MANAGER
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Name | CHIMENE PEREZ
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Credential |
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Telephone | 904-750-3344
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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