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General NPI Number Information
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NPI Number | 1508093733
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Entity Type | Individual
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Provider Name | JENNIFFIER EADY MD
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Gender | Female
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Dates
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Enumeration Date | 06/15/2009
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Last Update Date | 10/31/2022
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Provider Practice Location Address
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Address Line | 1150 N KIMBALL AVE STE 120
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City | SOUTHLAKE
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State | TX
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Zip | 76092-5570
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Country | US
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Telephone | 682-651-8007
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Fax | 844-750-0657
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Provider Business Mailing Address
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Address Line | 5 WOODLANDS CT
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City | TROPHY CLUB
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State | TX
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Zip | 76262-9735
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Country | US
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Telephone | 972-310-8872
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Fax | 844-750-0657
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | P4593
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License Number State | TX
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