Provider Demographics
NPI:1376752550
Name:BAUGHER, PRUDENCE JANE (PA-C)
Entity Type:Individual
Prefix:
First Name:PRUDENCE
Middle Name:JANE
Last Name:BAUGHER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:PRUDENCE
Other - Middle Name:JANE
Other - Last Name:SCHMITT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 7687
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MO
Mailing Address - Zip Code:65205-7687
Mailing Address - Country:US
Mailing Address - Phone:573-882-8612
Mailing Address - Fax:
Practice Address - Street 1:402 N KEENE ST
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MO
Practice Address - Zip Code:65201-6986
Practice Address - Country:US
Practice Address - Phone:573-882-2250
Practice Address - Fax:573-875-9500
Is Sole Proprietor?:No
Enumeration Date:2007-05-22
Last Update Date:2009-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003004297363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant