Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | 2019042805 | MO |
NPI | 1003452889 |
---|---|
Provider Name | Kevin Baer |
First Address | Bloomington, IN 47401-8824 |
Second Address | Saint Joseph, MO 64506-3488 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/11/2019 |
Last Update Date | 27/11/2019 |