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General NPI Number Information
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NPI Number | 1396371035
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Entity Type | Individual
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Provider Name | ALICIA NICHOLE HASQUIN PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/13/2020
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 5979 DESERT STORM AVE
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City | FORT CAMPBELL
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State | KY
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Zip | 42223-5514
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Country | US
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Telephone | 82-273-5348
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Fax |
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Provider Business Mailing Address
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Address Line | 332 W EDMUNDS ST
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City | HOPKINSVILLE
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State | KY
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Zip | 42240-1742
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Country | US
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Telephone |
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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