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General NPI Number Information
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NPI Number | 1427613470
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Entity Type | Individual
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Provider Name | KOSSA DIOMANDE
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Gender | Male
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Dates
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Enumeration Date | 05/06/2019
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Last Update Date | 08/28/2019
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Provider Practice Location Address
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Address Line | 100 FUNKHOUSER BUILDING
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City | LEXINGTON
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State | KY
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Zip | 40506-0001
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Country | US
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Telephone | 859-257-1754
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Fax |
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Provider Business Mailing Address
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Address Line | 3099 KIRKLEVINGTON DR APT 138
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City | LEXINGTON
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State | KY
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Zip | 40517-2480
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Country | US
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Telephone | 859-494-5888
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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 | MED-P
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License Number State | MT
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