Healthcare Provider Details

I. General information

NPI: 1467767095
Provider Name (Legal Business Name): TRACI L. KLINE FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TRACI L. BAIRD

II. Dates (important events)

Enumeration Date: 08/06/2010
Last Update Date: 11/27/2023
Certification Date: 10/11/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6996 COUNTY ROAD 326
PALMYRA MO
63461-3119
US

IV. Provider business mailing address

6996 COUNTY ROAD 326
PALMYRA MO
63461-3119
US

V. Phone/Fax

Practice location:
  • Phone: 573-769-3710
  • Fax: 573-769-3753
Mailing address:
  • Phone: 573-769-3710
  • Fax: 573-769-3753

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number2003029335
License Number StateMO
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2010026980
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: