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General NPI Number Information
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NPI Number | 1831850197
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Entity Type | Individual
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Provider Name | KRISTIN MOORE
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Gender | Female
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Dates
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Enumeration Date | 01/07/2022
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Last Update Date | 01/07/2022
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Provider Practice Location Address
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Address Line | 2214 EMERY ST STE 530
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City | DENTON
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State | TX
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Zip | 76201-2478
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Country | US
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Telephone | 469-225-3051
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Fax |
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Provider Business Mailing Address
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Address Line | 1008 CALUMET CT
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City | ROANOKE
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State | TX
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Zip | 76262-2087
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Country | US
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Telephone | 469-939-0585
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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 | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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