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General NPI Number Information
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NPI Number | 1902103666
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Entity Type | Individual
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Provider Name | AMANDA KAY VANLANDINGHAM D.O.
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Gender | Female
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Dates
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Enumeration Date | 02/16/2011
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Last Update Date | 02/17/2025
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Provider Practice Location Address
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Address Line | 310 N STATE OF FRANKLIN RD STE 303
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City | JOHNSON CITY
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State | TN
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Zip | 37604-6051
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Country | US
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Telephone | 423-926-8181
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Fax | 423-926-4421
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Provider Business Mailing Address
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Address Line | PO BOX 632476
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City | CINCINNATI
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State | OH
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Zip | 45263-2476
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Country | US
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Telephone | 423-926-8181
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Fax | 423-926-4421
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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 | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | 2519
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License Number State | TN
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Legacy Identifiers
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Identifier #1
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Identifier Code | Q004194
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Identifier Type | MEDICAID
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Identifier State | TN
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Identifier Issuer |
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Proprietary Identifiers Ever Reported
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Identifier #1
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Identifier Code | Q004194
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Identifier Type | MEDICAID
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Identifier State | TN
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Identifier Issuer |
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