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General NPI Number Information
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NPI Number | 1972479137
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Entity Type | Organization
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Legal Business Name | OLIVE BRANCH WAY PLLC
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Dates
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Enumeration Date | 10/15/2025
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 245 RIVERSIDE AVE STE 100
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City | JACKSONVILLE
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State | FL
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Zip | 32202-4930
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Country | US
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Telephone | 904-575-0628
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Fax | 904-506-1326
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Provider Business Mailing Address
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Address Line | 5501 WESCONNETT BLVD UNIT 14846
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City | JACKSONVILLE
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State | FL
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Zip | 32238-7769
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Country | US
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Telephone | 904-575-0628
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Fax | 904-506-1326
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Authorized Official
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Title or Position | OWNER
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Name | SHEREKIA HALES
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Credential | PMHNP
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Telephone | 904-710-0398
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number |
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License Number State |
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