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General NPI Number Information
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NPI Number | 1609575216
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Entity Type | Individual
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Provider Name | JAKE GALAN HARPER
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Gender | Male
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Dates
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Enumeration Date | 03/02/2023
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Last Update Date | 06/24/2025
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Provider Practice Location Address
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Address Line | 2201 LEXINGTON AVE
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City | ASHLAND
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State | KY
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Zip | 41101-2843
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Country | US
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Telephone | 606-408-4000
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Fax | 606-408-7426
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Provider Business Mailing Address
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Address Line | 440 SW SUNDANCE TRL
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City | PORT SAINT LUCIE
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State | FL
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Zip | 34953-8220
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Country | US
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Telephone | 561-906-1619
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | RN9452369
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | APRN.CRNA.0021301
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License Number State | OH
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Taxonomy #3
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Taxonomy Code | 367500000X
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Taxonomy Name | Certified Registered Nurse Anesthetist
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License Number | 4041650
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License Number State | KY
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