Provider Demographics
NPI:1275629511
Name:BAUGH, JANET L (NP)
Entity Type:Individual
Prefix:
First Name:JANET
Middle Name:L
Last Name:BAUGH
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:695 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:JASPER
Mailing Address - State:IN
Mailing Address - Zip Code:47546-3602
Mailing Address - Country:US
Mailing Address - Phone:812-634-6824
Mailing Address - Fax:812-481-1056
Practice Address - Street 1:104 WOOD ST
Practice Address - Street 2:
Practice Address - City:LOOGOOTEE
Practice Address - State:IN
Practice Address - Zip Code:47553-1260
Practice Address - Country:US
Practice Address - Phone:812-295-2955
Practice Address - Fax:812-295-2573
Is Sole Proprietor?:No
Enumeration Date:2006-10-05
Last Update Date:2014-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001604A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200504940Medicaid
INM400062117Medicare PIN
IN192780EMedicare ID - Type UnspecifiedMEDICARE
INM100061947Medicare PIN
INQ25229Medicare UPIN