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General NPI Number Information
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NPI Number | 1689508129
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Entity Type | Organization
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Legal Business Name | MYSPACE HEALTHCARE
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Dates
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Enumeration Date | 06/10/2026
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Last Update Date | 06/10/2026
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Provider Practice Location Address
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Address Line | 1101 NE HENDRIX DR
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City | LEES SUMMIT
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State | MO
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Zip | 64086-3519
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Country | US
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Telephone | 816-624-2094
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Fax | 816-207-0484
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Provider Business Mailing Address
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Address Line | 1309 COFFEEN AVE STE 17117
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City | SHERIDAN
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State | WY
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Zip | 82801-5777
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Country | US
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Telephone | 816-623-0580
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Fax | 816-207-0484
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Authorized Official
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Title or Position | DNP, FNP-C OWNER
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Name | CASSEY LYNN HALL
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Credential | HALL
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Telephone | 816-624-2094
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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 |
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License Number State |
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