Bautista, Kathleen Jo
Bautista, Kathleen Jo is an individual health care provider with primary practice located at 813-1 Chesapeake Drive , Cambridge MD 21613-9401. She recently has only one registered license in Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health, which is considered as her primary health care specialty. Bautista, Kathleen Jo can be contacted via phone (410) 221-2266.Contact Information
Primary practice address
813-1 Chesapeake Drive
Cambridge MD 21613-9401
Phone: (410) 221-2266
Fax: (410) 221-2878
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Psychiatric/Mental Health | 363LP0808X | R069915 | Maryland |
Profile Details
| NPI number | 1558483867 |
|---|---|
| LBN Legal business name | Bautista, Kathleen Jo |
| Credentials | CRNP |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Apr 6th, 2007 |
| Last updated | May 24th, 2012 - about 12 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1558483867 | NPPES |
| Maryland | Other | 499188 | VO-MHA |
| Maryland | MEDICAID | 609550002 | VO-MHA |
| Maryland | MEDICAID | 609550004 | VO-MHA |
| Maryland | MEDICAID | 479302100 | VO-MHA |
| Maryland | MEDICAID | 609550001 | VO-MHA |
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