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General NPI Number Information
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NPI Number | 1093459521
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Entity Type | Individual
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Provider Name | KEITH JUSTIN HAYNES NP
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Gender | Male
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Dates
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Enumeration Date | 04/21/2022
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Last Update Date | 04/21/2022
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Provider Practice Location Address
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Address Line | 43 PINNACLE DR
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City | FISHERSVILLE
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State | VA
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Zip | 22939-2448
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Country | US
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Telephone | 540-245-7262
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Fax | 540-245-7054
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Provider Business Mailing Address
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Address Line | 241 NORTHRIDGE RD
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City | RUCKERSVILLE
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State | VA
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Zip | 22968-3642
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Country | US
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Telephone | 540-250-4611
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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 | 363LA2100X
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Taxonomy Name | Acute Care Nurse Practitioner
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License Number | 0024182258
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License Number State | VA
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