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General NPI Number Information
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NPI Number | 1215636550
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Entity Type | Individual
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Provider Name | MRS. KALLAN ELAINE FIMPLE
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Gender | Female
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Dates
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Enumeration Date | 02/27/2023
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Last Update Date | 02/27/2023
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Provider Practice Location Address
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Address Line | 1630 E PRIMROSE ST
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City | SPRINGFIELD
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State | MO
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Zip | 65804-7929
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Country | US
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Telephone | 417-885-4700
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Fax |
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Provider Business Mailing Address
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Address Line | 172 QUINCY RD
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City | KIRBYVILLE
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State | MO
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Zip | 65679-9319
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Country | US
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Telephone | 918-645-0579
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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 | 225100000X
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Taxonomy Name | Physical Therapist
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License Number | 2023004369
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License Number State | MO
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