1609852896 NPI number — MRS. KIRSTEN SHANNON BAUTISTA FNP

Table of content: MRS. KIRSTEN SHANNON BAUTISTA FNP (NPI 1609852896)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609852896 NPI number — MRS. KIRSTEN SHANNON BAUTISTA FNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAUTISTA
Provider First Name:
KIRSTEN
Provider Middle Name:
SHANNON
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609852896
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/08/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
CMR 449
Provider Second Line Business Mailing Address:
BOX 712
Provider Business Mailing Address City Name:
APO
Provider Business Mailing Address State Name:
AE
Provider Business Mailing Address Postal Code:
09031
Provider Business Mailing Address Country Code:
DE
Provider Business Mailing Address Telephone Number:
093213058416
Provider Business Mailing Address Fax Number:
093213058946

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
USHC KITZINGEN
Provider Second Line Business Practice Location Address:
UNIT 26124
Provider Business Practice Location Address City Name:
APO
Provider Business Practice Location Address State Name:
AE
Provider Business Practice Location Address Postal Code:
09031
Provider Business Practice Location Address Country Code:
DE
Provider Business Practice Location Address Telephone Number:
093213058416
Provider Business Practice Location Address Fax Number:
093213058946
Provider Enumeration Date:
12/20/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  108956 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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