Healthcare Provider Details

I. General information

NPI: 1013684752
Provider Name (Legal Business Name): KACI BAUSKE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/29/2021
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E 86TH AVE STE K
MERRILLVILLE IN
46410-6236
US

IV. Provider business mailing address

521 E 86TH AVE STE K
MERRILLVILLE IN
46410-6236
US

V. Phone/Fax

Practice location:
  • Phone: 219-769-5227
  • Fax:
Mailing address:
  • Phone: 219-309-6542
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number71011929A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71011929A
License Number StateIN
# 3
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28217390A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: