1629131487 NPI number — DR. STACEY M BALDWIN AUD CCC A

Table of content: DR. STACEY M BALDWIN AUD CCC A (NPI 1629131487)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629131487 NPI number — DR. STACEY M BALDWIN AUD CCC A

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BALDWIN
Provider First Name:
STACEY
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
AUD CCC A
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:
1629131487
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/27/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7301 MISSION RD STE 146
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PRAIRIE VILLAGE
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
66208-3005
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
913-384-2105
Provider Business Mailing Address Fax Number:
913-384-0735

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7301 MISSION RD STE 140
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PRAIRIE VILLAGE
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
66208-3005
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
913-262-5855
Provider Business Practice Location Address Fax Number:
913-262-5869
Provider Enumeration Date:
12/19/2006

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: 231H00000X , with the licence number:  1994 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 231H00000X , with the licence number: 1325 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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