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General NPI Number Information
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NPI Number | 1518272129
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Entity Type | Organization
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Legal Business Name | KEITH B. KESSEL M.D., LLC
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Dates
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Enumeration Date | 08/09/2010
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Last Update Date | 08/09/2010
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Provider Practice Location Address
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Address Line | 745 OLIVE ST STE 109
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City | SHREVEPORT
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State | LA
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Zip | 71104-2250
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Country | US
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Telephone | 318-221-6070
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Fax | 318-221-6069
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Provider Business Mailing Address
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Address Line | 745 OLIVE ST STE 109
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City | SHREVEPORT
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State | LA
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Zip | 71104-2250
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Country | US
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Telephone | 318-221-6070
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Fax | 318-221-6069
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | CANDEE CARMAN
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Credential |
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Telephone | 318-221-6070
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0805X
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Taxonomy Name | Geriatric Psychiatry Physician
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License Number | 10227R
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License Number State | LA
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Taxonomy #2
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | 10227R
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License Number State | LA
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