Healthcare Provider Details

I. General information

NPI: 1881311512
Provider Name (Legal Business Name): KALLIE BATEMAN FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/24/2022
Last Update Date: 04/15/2024
Certification Date: 04/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4742 FARM ROAD 2140
EXETER MO
65647-7260
US

IV. Provider business mailing address

4742 FARM ROAD 2140
EXETER MO
65647-7260
US

V. Phone/Fax

Practice location:
  • Phone: 417-342-3598
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2018002456
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2023007998
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2023007998
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: