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General NPI Number Information
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NPI Number | 1104797679
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Entity Type | Individual
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Provider Name | JASON KYLE FISHER
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Gender | Male
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Dates
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Enumeration Date | 09/16/2025
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 104 S SCHILLER AVE
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City | WALLACE
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State | NE
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Zip | 69169
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Country | US
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Telephone | 720-345-4876
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 HALLIGAN DR
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City | NORTH PLATTE
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State | NE
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Zip | 69101-7659
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Country | US
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Telephone | 720-345-4876
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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 | 374U00000X
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Taxonomy Name | Home Health Aide
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License Number | H14172980
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License Number State | NE
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