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General NPI Number Information
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NPI Number | 1710389986
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Entity Type | Individual
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Provider Name | KYLE MICHAEL SHOMAKER CDM, CFPP
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Gender | Male
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Dates
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Enumeration Date | 09/19/2014
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Last Update Date | 09/19/2014
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Provider Practice Location Address
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Address Line | 1061 HARMON AVE BLDG 302
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City | FORT STEWART
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State | GA
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Zip | 31314-5641
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Country | US
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Telephone | 912-435-6739
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Fax | 912-435-6923
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Provider Business Mailing Address
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Address Line | 1061 HARMON AVE BUILDING 302
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City | FORT STEWART
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State | GA
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Zip | 31314-5641
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Country | US
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Telephone | 912-435-6739
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Fax | 912-435-6923
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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 | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number | 312779716
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License Number State | GA
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