Provider Demographics
NPI:1992455174
Name:BAUGHMAN, THERESA RAE (CRNA)
Entity type:Individual
Prefix:
First Name:THERESA
Middle Name:RAE
Last Name:BAUGHMAN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:444 FOUR STATES DR STE 2
Mailing Address - Street 2:
Mailing Address - City:GALENA
Mailing Address - State:KS
Mailing Address - Zip Code:66739-4325
Mailing Address - Country:US
Mailing Address - Phone:417-438-6984
Mailing Address - Fax:
Practice Address - Street 1:444 FOUR STATES DR STE 1
Practice Address - Street 2:
Practice Address - City:GALENA
Practice Address - State:KS
Practice Address - Zip Code:66739-4325
Practice Address - Country:US
Practice Address - Phone:417-438-6984
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-28
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014002405163W00000X
MO2022028091367500000X
KS43-558014-102367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse