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General NPI Number Information
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NPI Number | 1730631508
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Entity Type | Individual
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Provider Name | BOBIE CALICUTT
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Gender | Female
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Dates
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Enumeration Date | 10/27/2016
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Last Update Date | 06/24/2021
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Provider Practice Location Address
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Address Line | 2055 CRAIGSHIRE RD STE 420F
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4043
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Country | US
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Telephone | 816-400-4276
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Fax | 314-887-7004
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Provider Business Mailing Address
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Address Line | 2055 CRAIGSHIRE RD STE 420F
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City | SAINT LOUIS
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State | MO
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Zip | 63146-4043
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Country | US
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Telephone | 816-400-4276
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Fax | 314-887-7004
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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 | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number |
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 172V00000X
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Taxonomy Name | Community Health Worker
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License Number | T208137023
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License Number State | MO
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