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General NPI Number Information
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NPI Number | 1437550167
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Entity Type | Individual
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Provider Name | KEITHA ANN JACELLARI APRN, FNP-BC
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Gender | Female
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Dates
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Enumeration Date | 09/12/2014
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Last Update Date | 05/31/2023
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Provider Practice Location Address
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Address Line | 1335 E REPUBLIC RD
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City | SPRINGFIELD
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State | MO
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Zip | 65804-7248
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Country | US
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Telephone | 417-363-3900
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Fax | 417-313-9998
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Provider Business Mailing Address
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Address Line | PO BOX 2452
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City | MOUNTAIN VIEW
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State | AR
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Zip | 72560-2452
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Country | US
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Telephone | 870-615-0825
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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 | A004137
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License Number State | AR
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