Individual
MRS. KATHLEEN JO BAUTISTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNP
Contact information
Practice address
813-1 CHESAPEAKE DRIVE, CAMBRIDGE, MD 21613-9401
(410) 221-2266
(410) 221-2878
Mailing address
813-1 CHESAPEAKE DRIVE, CAMBRIDGE, MD 21613-9401
(410) 221-2266
(410) 221-2878
Taxonomy
Speciality
Code
Description
License number
State
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
R069915
MD
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
479302100
—
MD
01
—
499188
VO-MHA
MD
05
—
609550001
—
MD
05
—
609550002
—
MD
05
—
609550004
—
MD
Enumeration date
04/06/2007
Last updated
05/24/2012
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