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General NPI Number Information
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NPI Number | 1770147852
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Entity Type | Individual
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Provider Name | SARAH ELIZABETH BULLARD RD LD
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Gender | Female
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Dates
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Enumeration Date | 04/24/2019
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Last Update Date | 02/10/2026
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Provider Practice Location Address
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Address Line | 409 E LAKEWOOD ST
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2531
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Country | US
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Telephone | 660-238-3530
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Fax |
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Provider Business Mailing Address
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Address Line | 409 E LAKEWOOD ST
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City | NACOGDOCHES
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State | TX
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Zip | 75965-2531
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Country | US
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Telephone | 660-238-3530
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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 | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 2009035995
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number | 981995
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License Number State | MO
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