Healthcare Provider Details

I. General information

NPI: 1124051941
Provider Name (Legal Business Name): KRISTIE A BAKER M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: KRISTIE A RUTLEDGE M.D.

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 12/04/2025
Certification Date: 12/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19600 E 39TH ST S
INDEPENDENCE MO
64057-2301
US

IV. Provider business mailing address

19600 E 39TH ST S
INDEPENDENCE MO
64057-2301
US

V. Phone/Fax

Practice location:
  • Phone: 913-222-9779
  • Fax: 816-312-8340
Mailing address:
  • Phone: 913-222-9779
  • Fax: 816-312-8340

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number0427424
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number103472
License Number StateMO
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number0427424
License Number StateKS
# 4
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number103472
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: