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General NPI Number Information
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NPI Number | 1740958842
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Entity Type | Individual
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Provider Name | TYLER BATCHELOR
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Gender | Male
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Dates
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Enumeration Date | 09/02/2021
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Last Update Date | 09/02/2021
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Provider Practice Location Address
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Address Line | 1300 1ST ST
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City | KENNETT
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State | MO
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Zip | 63857-2526
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Country | US
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Telephone | 573-888-8880
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Fax |
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Provider Business Mailing Address
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Address Line | 20075 STATE HIGHWAY 25
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City | BLOOMFIELD
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State | MO
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Zip | 63825-8224
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Country | US
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Telephone | 573-625-2383
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 2019032438
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License Number State | MO
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