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General NPI Number Information
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NPI Number | 1164631628
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Entity Type | Individual
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Provider Name | PATRICK KELLY M.D.
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Gender | Female
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3599 UNIVERSITY BLVD S BLDG. 1200
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4252
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Country | US
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Telephone | 904-398-8005
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Fax | 904-398-2771
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Provider Business Mailing Address
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Address Line | 3599 UNIVERSITY BLVD S BLDG. 1200
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City | JACKSONVILLE
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State | FL
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Zip | 32216-4252
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Country | US
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Telephone | 904-398-8005
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Fax | 904-398-2771
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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 | 261QA0005X
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Taxonomy Name | Ambulatory Family Planning Facility
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License Number | ME 69167
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License Number State | FL
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