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NPI Code Detail

MEDICARE: KRISTY KEATON-BAIRD NP

MEDICARE: KRISTY KEATON-BAIRD NP
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
1363LA2200XAdult Health Nurse PractitionerCOA.08307-NPOH
2363LP2300XPrimary Care Nurse Practitioner4704192639MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
102214OTHEROHPARAMOUNT
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
360886OTHERMIHEALTH PLAN OF MICHIGAN

General Provider Information

NPI Number : 1730161290
Entity Type Code : Individual
Provider Name (Legal Business Name) : KRISTY KEATON-BAIRD NP
Provider Business Mailing Address
First Line : 8765 LEWIS AVE
Second Line :
City : TEMPERANCE
State : MI
Zip : 48182-9583
Country : US
Telephone Number : 734-847-3802
Fax Number : 734-847-3418
Provider Business Practice Location Address
First Line : 8765 LEWIS AVE
Second Line :
City : TEMPERANCE
State : MI
Zip : 48182-9583
Country : US
Telephone Number : 734-847-3802
Fax Number : 734-847-3418
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2005
Last Update Date : 02/02/2023

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