Healthcare Provider Details

I. General information

NPI: 1376752550
Provider Name (Legal Business Name): PRUDENCE JANE BAUGHER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PRUDENCE JANE SCHMITT

II. Dates (important events)

Enumeration Date: 05/22/2007
Last Update Date: 10/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 N KEENE ST
COLUMBIA MO
65201-6986
US

IV. Provider business mailing address

PO BOX 7687
COLUMBIA MO
65205-7687
US

V. Phone/Fax

Practice location:
  • Phone: 573-882-2250
  • Fax: 573-875-9500
Mailing address:
  • Phone: 573-882-8612
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number2003004297
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: