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General NPI Number Information
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NPI Number | 1720559651
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Entity Type | Individual
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Provider Name | TRISTYN ADLENA PIERCE
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Gender | Female
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Dates
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Enumeration Date | 12/17/2018
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Last Update Date | 12/17/2018
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Provider Practice Location Address
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Address Line | 6051 W HICKORY GROVE RD
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City | LETOHATCHEE
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State | AL
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Zip | 36047-5413
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Country | US
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Telephone | 334-782-9378
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Fax |
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Provider Business Mailing Address
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Address Line | 506B GIBBS ST
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City | TROY
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State | AL
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Zip | 36081-4738
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Country | US
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Telephone | 334-782-9378
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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 | 2255A2300X
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Taxonomy Name | Athletic Trainer
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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