MEDICARE: MRS. CONNIE BAKER KLOTZBACH PA-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	363A00000X	Physician Assistant	PA00315	MS

General Provider Information

NPI Number	:	1225576820
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. CONNIE BAKER KLOTZBACH PA-C

Provider Business Mailing Address
First Line	:	2101 HIGHWAY 90
Second Line	:
City	:	GAUTIER
State	:	MS
Zip	:	39553-5340
Country	:	US
Telephone Number	:	228-497-7576
Fax Number	:	228-497-8869

Provider Business Practice Location Address
First Line	:	3603 BIENVILLE BLVD STE 102
Second Line	:
City	:	OCEAN SPRINGS
State	:	MS
Zip	:	39564-5736
Country	:	US
Telephone Number	:	228-818-9620
Fax Number	:	228-818-9750

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

Provider Enumeration Date	:	02/03/2017
Last Update Date	:	01/14/2026

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