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General NPI Number Information
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NPI Number | 1891214474
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Entity Type | Individual
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Provider Name | KATIE ANN KELLEY AU.D.
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Gender | Female
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Dates
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Enumeration Date | 09/14/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 6355 WALKER LN STE 411
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City | ALEXANDRIA
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State | VA
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Zip | 22310-3250
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Country | US
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Telephone | 703-922-4262
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Fax |
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Provider Business Mailing Address
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Address Line | 702 MASON RD
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City | STEVENSVILLE
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State | MD
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Zip | 21666-2318
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Country | US
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Telephone | 443-496-2450
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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 | 231H00000X
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Taxonomy Name | Audiologist
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License Number | 2201001641
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License Number State | VA
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