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General NPI Number Information
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NPI Number | 1710896402
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Entity Type | Individual
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Provider Name | JACOB KYLE FAUST PMHNP-BC
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Gender |
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Dates
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Enumeration Date | 09/07/2026
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Last Update Date | 09/07/2026
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Provider Practice Location Address
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Address Line | 206 MARIA HALL DR
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City | DANVILLE
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State | PA
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Zip | 17821-1304
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Country | US
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Telephone | 570-953-8552
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Fax |
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Provider Business Mailing Address
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Address Line | 358 SUNBURY RD
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City | DANVILLE
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State | PA
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Zip | 17821-8789
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Country | US
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Telephone | 570-394-2933
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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 | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | SP036645
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License Number State | PA
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