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General NPI Number Information
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NPI Number | 1104411230
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Entity Type | Individual
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Provider Name | KELSEY LYN TILLMAN DNP, APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 03/01/2021
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Last Update Date | 03/20/2026
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Provider Practice Location Address
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Address Line | 500 MARKET ST STE 300
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City | FULTON
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State | MO
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Zip | 65251-2808
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Country | US
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Telephone | 573-200-6078
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Fax | 833-817-7109
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Provider Business Mailing Address
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Address Line | 500 MARKET ST STE 300
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City | FULTON
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State | MO
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Zip | 65251-2808
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Country | US
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Telephone | 573-200-6078
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Fax | 833-817-7109
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2015001994
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2021007044
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License Number State | MO
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