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General NPI Number Information
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NPI Number | 1740718873
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Entity Type | Individual
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Provider Name | KAYLA COLVILL MD
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Gender | Female
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Dates
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Enumeration Date | 06/02/2017
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Last Update Date | 09/05/2024
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Provider Practice Location Address
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Address Line | 1325 PENNSYLVANIA AVE STE 560
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City | FORT WORTH
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State | TX
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Zip | 76104-2152
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Country | US
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Telephone | 817-250-7240
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Fax |
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Provider Business Mailing Address
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Address Line | 1401 ELM ST APT 4207
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City | DALLAS
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State | TX
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Zip | 75202-2928
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Country | US
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Telephone | 713-515-8977
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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 | 208600000X
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Taxonomy Name | Surgery Physician
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License Number | T3060
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License Number State | TX
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