MRS. KATHLEEN JO BAUTISTA (NPI# 1558483867) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1558483867 |
| Entity Type | Individual |
| Full Name | MRS. KATHLEEN JO BAUTISTA |
| Credential | CRNP |
| Practice Address |
813-1 Chesapeake Drive Cambridge MD 21613-9401 |
| Practice Telephone | 4102212266 |
| Practice Fax Number | 4102212878 |
| Mailing Telephone | 4102212266 |
| Mailing Fax Number | 4102212878 |
| Enumeration Date | 2007-04-06 |
| Last Update Date | 2012-05-24 |
| Gender Code | F |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363LP0808X |
Nurse Practitioner Specialization: Psych/Mental Health |
R069915 | MD | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | VO-MHA | 499188 | 01 |
| MD | 479302100 | 05 | |
| MD | 609550001 | 05 | |
| MD | 609550002 | 05 | |
| MD | 609550004 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063836104 | Kathleen Elizabeth Bautista | Social Worker | 520 N 4th St, Springfield, IL 62702 | 2014-02-10 |
| Street Address |
813-1 CHESAPEAKE DRIVE |
| City | CAMBRIDGE |
| State | MD |
| Zip Code | 21613-9401 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780670067 | Lori Ruth Powley | Social Worker | 813-1 Chesapeake Drive, Cambridge, MD 21613-9401 | 2005-09-22 |
| 1477886679 | Judith Ann Cannon | Social Worker | 813-1 Chesapeake Drive, Cambridge, MD 21613-9401 | 2009-09-08 |
| 1346489432 | Suzan Parker | Social Worker | 813-1 Chesapeake Drive, Cambridge, MD 21613-9401 | 2009-02-12 |
| 1265628549 | Martha Ann Clevenger | Psychiatry & Neurology | 813-1 Chesapeake Drive, Cambridge, MD 21613-9401 | 2007-09-19 |
| 1093859357 | Donna Lenore Beitel | Psychiatry & Neurology | 813-1 Chesapeake Drive, Cambridge, MD 21613-9401 | 2007-02-19 |
| 1447394713 | Patricia Brown | Social Worker | 813-1 Chesapeake Drive, Cambridge, MD 21613-9401 | 2007-02-19 |
| 1093859266 | Wendy Hare Simpson | Social Worker | 813-1 Chesapeake Drive, Cambridge, MD 21613-9401 | 2007-02-19 |
| 1639213226 | Gerald Lee Beemer | Counselor | 813-1 Chesapeake Drive, Cambridge, MD 21613-9401 | 2007-02-16 |
| 1043367725 | Marjorie Jean Boone | Registered Nurse | 813-1 Chesapeake Drive, Cambridge, MD 21613-9401 | 2007-01-04 |
| 1093897803 | Marshy Hope Family Services, LLC | Clinical Nurse Specialist | 813-1 Chesapeake Drive, Cambridge, MD 21613-9401 | 2006-10-20 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1225427289 | A Better Alternative Nursing Avency, Inc | Nursing Care | 204 Cedar Street, Canbridge, MD 21613 | 2015-01-14 |
| 1497048524 | Christina Marie Drostin | Family Medicine | 503 A Muir Street, Cambridge, MD 21613 | 2011-05-23 |
| 1841589058 | Wal-mart Stores East Lp | Technician/Technologist | 2775 Dorchester Square, Cambridge, MD 21613 | 2011-03-29 |
| 1053624452 | Gina Exantus-bernard | Pediatrics | 400 Byrn St Ste A, Cambridge, MD 21613 | 2010-07-14 |
| 1235362872 | St of Md/dhmh Dorchester Co Health Dept | Public Health or Welfare | 2475 Cambridge Bypass, Cambridge, MD 21613 | 2009-08-31 |
| 1801916622 | Alisha Foxwell Saulsbury | Social Worker | 208 Cedar St, Cambridge, MD 21613 | 2007-03-29 |
| 1497890669 | Charles Edmund Connelly Jr. | Dentist | 406 Lecompte Street, Cambridge, MD 21613 | 2007-02-21 |
| 1114088192 | Delmarva Community Services Inc | Nursing Care | 6210 Shiloh Church Hurlock Rd, Hurlock, MD 21613 | 2006-12-13 |
| 1184782658 | Lesa M Lee | Social Worker | 403 Race Street, Cambridge, MD 21613 | 2006-12-05 |
| 1750455747 | Jenny Lynne Jarrell | Social Worker | 208 Cedar Street, Cambridge, MD 21613 | 2006-11-20 |
| Find all providers in zip 21613 | ||||
| Taxonomy Code | 363LP0808X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Nurse Practitioner |
| Specialization | Psych/Mental Health |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1912543612 | Elizabeth Tadie | Nurse Practitioner | 8 Allen St Apt 2, Cambridge, MA 02140-1360 | 2019-11-18 |
| 1528054806 | Andrea D Markwalter | Nurse Practitioner | 828 Airpax Rd, Suite 300b, Cambridge, MD 21613-6405 | 2005-09-22 |
| 1073129300 | Sonja Theobald | Nurse Practitioner | 145 2nd Ave Se, Cambridge, MN 55008-1602 | 2020-09-22 |
| 1851905491 | Alexa L Burley | Nurse Practitioner | 300 Byrn St, Cambridge, MD 21613-1908 | 2020-09-01 |
| 1710536834 | Alida Bushe | Nurse Practitioner | 813 Chesapeake Dr Ste 1, Cambridge, MD 21613-9405 | 2019-09-11 |
| 1093360877 | Michelle Kay Schultz | Nurse Practitioner | 701 Dellwood St S, Cambridge, MN 55008-1920 | 2019-08-07 |
| 1184284366 | Abigail Irene Christensen | Nurse Practitioner | 701 Dellwood St S, Cambridge, MN 55008-1920 | 2019-06-19 |
| 1417436692 | Katrina Pauline Karbowniczak | Nurse Practitioner | 3 Bow St, Cambridge, MA 02138-5109 | 2018-08-09 |
| 1447743406 | Jennifer L Duppert | Nurse Practitioner | 3 Bow St, Cambridge, MA 02138-5109 | 2018-06-13 |
| 1548785017 | Leslie Fox | Nurse Practitioner | 300 Byrn St, Cambridge, MD 21613-1908 | 2017-08-07 |
| Find all providers in CAMBRIDGE | ||||
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.