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General NPI Number Information
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NPI Number | 1619491057
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Entity Type | Individual
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Provider Name | KAYLA RENAE SHERROUSE ARNP
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Gender | Female
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Dates
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Enumeration Date | 07/27/2017
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Last Update Date | 08/14/2024
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Provider Practice Location Address
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Address Line | 495 SAINT JOHNS RD
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City | BONIFAY
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State | FL
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Zip | 32425-4237
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Country | US
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Telephone | 850-547-5547
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Fax |
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Provider Business Mailing Address
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Address Line | 403 E 11TH ST
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City | PANAMA CITY
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State | FL
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Zip | 32401-3409
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Country | US
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Telephone | 850-747-5599
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Fax | 850-872-4131
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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 | ARNP9270919
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | APRN9270919
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License Number State | FL
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