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General NPI Number Information
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NPI Number | 1972344992
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Entity Type | Organization
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Legal Business Name | AUTHENTIC PSYCHIATRY & WELLNESS LLC
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Dates
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Enumeration Date | 06/04/2024
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Last Update Date | 06/04/2024
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Provider Practice Location Address
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Address Line | 220 E VIRGINIA ST
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City | EVANSVILLE
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State | IN
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Zip | 47711-5530
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Country | US
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Telephone | 812-777-0127
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3276
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City | EVANSVILLE
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State | IN
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Zip | 47731-3276
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Country | US
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Telephone | 812-473-0181
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LAURA ALEXANDER
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Credential | PMHNP
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Telephone | 812-777-0127
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number |
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License Number State |
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