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General NPI Number Information
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NPI Number | 1295082568
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Entity Type | Individual
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Provider Name | AMANDA LEIGH HARRELL F.N.P.-C
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Gender | Female
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Dates
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Enumeration Date | 08/06/2012
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Last Update Date | 06/29/2016
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Provider Practice Location Address
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Address Line | 600 S PINE ST
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City | DERIDDER
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State | LA
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Zip | 70634-4942
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Country | US
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Telephone | 337-462-7100
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 504
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City | DRY CREEK
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State | LA
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Zip | 70637-0504
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Country | US
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Telephone | 337-302-2739
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP08787
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN122253
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License Number State | LA
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