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General NPI Number Information
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NPI Number | 1134090061
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Entity Type | Organization
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Legal Business Name | PROVISION HEALTH CARE LLC
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Dates
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Enumeration Date | 09/15/2025
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Last Update Date | 09/15/2025
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Provider Practice Location Address
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Address Line | 525 W FAULKNER ST
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City | EL DORADO
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State | AR
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Zip | 71730-4518
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Country | US
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Telephone | 870-337-2009
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 510
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City | WEST MONROE
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State | LA
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Zip | 71294-0510
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Country | US
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Telephone | 318-322-9252
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Fax | 318-322-2885
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Authorized Official
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Title or Position | PRACTICE MANAGER
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Name | JACEY MELOY
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Credential |
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Telephone | 318-322-9252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number |
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License Number State |
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