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General NPI Number Information
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NPI Number | 1790756393
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Entity Type | Organization
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Legal Business Name | HOME CARE CLINIC AND SERVICES
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Dates
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Enumeration Date | 01/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 2055 WOOTON RD
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City | WOOTON
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State | KY
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Zip | 41776-8751
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Country | US
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Telephone | 606-279-2000
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Fax | 606-279-5033
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Provider Business Mailing Address
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Address Line | PO BOX 1327
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City | HAZARD
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State | KY
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Zip | 41702-1327
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Country | US
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Telephone | 606-279-2000
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Fax | 606-279-5033
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Authorized Official
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Title or Position | PARTNER
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Name | MRS. ANGELA K SHEPHERD
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Credential | LPN
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Telephone | 606-279-2000
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 2560P
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License Number State | KY
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