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General NPI Number Information
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NPI Number | 1114087467
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Entity Type | Organization
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Legal Business Name | KELLI JONES
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Dates
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Enumeration Date | 12/09/2006
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Last Update Date | 01/23/2008
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Provider Practice Location Address
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Address Line | 887 NOB HL
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City | WOLFE CITY
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State | TX
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Zip | 75496-3007
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Country | US
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Telephone | 903-496-9255
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Fax |
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Provider Business Mailing Address
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Address Line | 887 NOB HL
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City | WOLFE CITY
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State | TX
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Zip | 75496-3007
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Country | US
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Telephone | 903-496-9255
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Fax |
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Authorized Official
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Title or Position | SOLE PROPRIETOR,OWNER
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Name | MRS. KELLI LEANN JONES
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Credential |
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Telephone | 903-496-9255
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3104A0625X
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Taxonomy Name | Assisted Living Facility (Mental Illness)
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License Number |
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License Number State |
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