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General NPI Number Information
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NPI Number | 1710971031
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Entity Type | Individual
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Provider Name | PATRICIA ANN PROVOST ARNP
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Gender | Female
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Dates
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Enumeration Date | 08/31/2005
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 225 ABRAHAM FLEXNER WAY
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City | LOUISVILLE
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State | KY
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Zip | 40202-1846
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Country | US
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Telephone | 502-561-4263
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Fax |
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Provider Business Mailing Address
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Address Line | 7709 ADAM STEVEN CIR
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City | LOUISVILLE
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State | KY
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Zip | 40220-5714
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Country | US
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Telephone | 502-493-9917
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 4159P
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 71001676A
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License Number State | IN
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