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General NPI Number Information
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NPI Number | 1639082969
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Entity Type | Organization
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Legal Business Name | MODERN ROOTS HEALTHCARE, PLLC
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Dates
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Enumeration Date | 09/26/2026
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Last Update Date | 09/26/2026
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Provider Practice Location Address
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Address Line | 1140 WABASH RD
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City | UPTON
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State | KY
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Zip | 42784-9222
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Country | US
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Telephone | 270-766-7676
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Fax |
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Provider Business Mailing Address
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Address Line | 1140 WABASH RD
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City | UPTON
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State | KY
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Zip | 42784-9222
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Country | US
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Telephone | 270-766-7676
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Fax | 270-246-9774
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Authorized Official
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Title or Position | OWNER/ APRN
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Name | MRS. ABBY CARTER
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Credential | APRN
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Telephone | 270-766-7676
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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