=====================================================
General NPI Number Information
=====================================================
NPI Number | 1467234864
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JENNA CATHERINE BALDWIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/19/2023
-----------------------------------------------------
Last Update Date | 10/19/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 KELLOGG CIR
-----------------------------------------------------
City | EMPORIA
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 66801-5087
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-217-7488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1008 W 10TH ST
-----------------------------------------------------
City | NEWTON
-----------------------------------------------------
State | KS
-----------------------------------------------------
Zip | 67114-1540
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 316-217-7488
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------