Healthcare Provider Details

I. General information

NPI: 1396103370
Provider Name (Legal Business Name): ALLISON BAKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/04/2016
Last Update Date: 01/10/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1150 STATE HIGHWAY 248 STE 200
BRANSON MO
65616-4186
US

IV. Provider business mailing address

PO BOX 4046
SPRINGFIELD MO
65808-4046
US

V. Phone/Fax

Practice location:
  • Phone: 417-336-7112
  • Fax: 417-335-4684
Mailing address:
  • Phone: 417-269-7241
  • Fax: 417-269-7567

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number128398
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2016003664
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: