MEDICARE: MRS. TABITHA MARIE BAUDENDISTEL BSN, RN, MSN, FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2024009298	MO

General Provider Information

NPI Number	:	1174381701
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TABITHA MARIE BAUDENDISTEL BSN, RN, MSN, FNP-C

Provider Business Mailing Address
First Line	:	7409 LEONA ST
Second Line	:
City	:	SAINT LOUIS
State	:	MO
Zip	:	63116-2733
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	154 SAINT PETERS CENTRE BLVD
Second Line	:
City	:	SAINT PETERS
State	:	MO
Zip	:	63376-1695
Country	:	US
Telephone Number	:	636-552-9647
Fax Number	:	636-206-8548

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/08/2024
Last Update Date	:	03/24/2026

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