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General NPI Number Information
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NPI Number | 1174381701
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Entity Type | Individual
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Provider Name | TABITHA MARIE BAUDENDISTEL BSN, RN, MSN, FNP-C
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Gender | Female
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Dates
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Enumeration Date | 03/08/2024
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Last Update Date | 01/28/2026
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Provider Practice Location Address
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Address Line | 154 SAINT PETERS CENTRE BLVD
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City | SAINT PETERS
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State | MO
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Zip | 63376-1695
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Country | US
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Telephone | 636-552-9647
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Fax |
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Provider Business Mailing Address
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Address Line | 7409 LEONA ST
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City | SAINT LOUIS
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State | MO
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Zip | 63116-2733
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 2024009298
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License Number State | MO
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