Basic Information
Provider Information | |||||||||
NPI: | 1700174802 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | BAUGHMAN | ||||||||
FirstName: | KRISTEN | ||||||||
MiddleName: | ELIZABETH | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: | APRN | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | BASSETT OR RICHARDSON | ||||||||
OtherFirstName: | KRISTEN | ||||||||
OtherMiddleName: | ELIZABETH | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 480 GALLETTI WAY | ||||||||
Address2: |   | ||||||||
City: | SPARKS | ||||||||
State: | NV | ||||||||
PostalCode: | 894315564 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7756883321 | ||||||||
FaxNumber: | 7756883306 | ||||||||
Practice Location | |||||||||
Address1: | 480 GALLETTI WAY | ||||||||
Address2: |   | ||||||||
City: | SPARKS | ||||||||
State: | NV | ||||||||
PostalCode: | 89431 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7756883321 | ||||||||
FaxNumber: | 7756883306 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 07/11/2011 | ||||||||
LastUpdateDate: | 08/28/2018 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | N | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363L00000X | APN001298 | NV | Y |   | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |   |
ID Information
ID | Type | State | Issuer | Description | 1700174802 | 05 | NV |   | MEDICAID |