Provider Demographics
NPI:1154770014
Name:BAUMERT, KRISTIN KARA NELSON (PA-C)
Entity type:Individual
Prefix:MS
First Name:KRISTIN
Middle Name:KARA NELSON
Last Name:BAUMERT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:KRISTIN
Other - Middle Name:KARA
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5 W MENDENHALL ST STE 202
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-3566
Mailing Address - Country:US
Mailing Address - Phone:406-219-7233
Mailing Address - Fax:
Practice Address - Street 1:5 W MENDENHALL ST STE 202
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-3566
Practice Address - Country:US
Practice Address - Phone:406-219-7233
Practice Address - Fax:866-284-8967
Is Sole Proprietor?:No
Enumeration Date:2016-06-10
Last Update Date:2024-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTMED-PAC-LIC-51706363A00000X, 363A00000X
MT51706364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health