Healthcare Provider Details

I. General information

NPI: 1891068896
Provider Name (Legal Business Name): KATHERINE M BAKER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/22/2012
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MERCY WAY STE 530
JOPLIN MO
64804-4524
US

IV. Provider business mailing address

100 MERCY WAY STE 530
JOPLIN MO
64804-4524
US

V. Phone/Fax

Practice location:
  • Phone: 417-556-3828
  • Fax:
Mailing address:
  • Phone: 417-556-3828
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2009000360
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2012005798
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: