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General NPI Number Information
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NPI Number | 1619453552
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Entity Type | Individual
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Provider Name | KYLEE MAUREEN BAKKER
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Gender | Female
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Dates
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Enumeration Date | 07/13/2018
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 1400 29TH ST S
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City | GREAT FALLS
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State | MT
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Zip | 59405-5315
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Country | US
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Telephone | 406-771-3252
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Fax |
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Provider Business Mailing Address
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Address Line | 19 N WISCONSIN ST
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City | CONRAD
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State | MT
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Zip | 59425-1829
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Country | US
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Telephone | 406-781-3998
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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 | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | NUR-APRN-LIC-176062
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License Number State | MT
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Taxonomy #2
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Taxonomy Code | 363LP0200X
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Taxonomy Name | Pediatric Nurse Practitioner
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License Number | AP60854096
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License Number State | WA
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