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General NPI Number Information
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NPI Number | 1972469146
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Entity Type | Organization
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Legal Business Name | RESILIENT ROOTS
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Dates
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Enumeration Date | 12/31/2025
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Last Update Date | 01/02/2026
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Provider Practice Location Address
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Address Line | 13137 UNIVERSITY AVE STE 140
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City | CLIVE
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State | IA
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Zip | 50325-8299
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Country | US
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Telephone | 515-317-8752
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Fax | 515-717-1040
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Provider Business Mailing Address
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Address Line | 1650 280TH ST
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City | MADRID
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State | IA
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Zip | 50156-7530
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Country | US
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Telephone | 515-230-3308
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Fax |
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Authorized Official
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Title or Position | CREDENTIALING COORDINATOR
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Name | JAMIE ROYS
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Credential |
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Telephone | 515-230-3308
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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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