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General NPI Number Information
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NPI Number | 1972165215
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Entity Type | Individual
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Provider Name | KYRSTEN JAQUELYN WITHEM NONE
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Gender | Female
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Dates
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Enumeration Date | 07/08/2019
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Last Update Date | 07/08/2019
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Provider Practice Location Address
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Address Line | 111 W ANDERSON LN # D202B
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City | AUSTIN
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State | TX
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Zip | 78752-1132
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Country | US
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Telephone | 512-493-9755
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Fax | 866-242-3803
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Provider Business Mailing Address
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Address Line | 111 W ANDERSON LN # D202B
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City | AUSTIN
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State | TX
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Zip | 78752-1132
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Country | US
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Telephone | 512-493-9755
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Fax | 866-242-3803
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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 | 171M00000X
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Taxonomy Name | Case Manager/Care Coordinator
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License Number |
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License Number State |
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