Provider Demographics
NPI:1609852896
Name:BAUTISTA, KIRSTEN SHANNON (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:SHANNON
Last Name:BAUTISTA
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
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Mailing Address - Street 1:CMR 449
Mailing Address - Street 2:BOX 712
Mailing Address - City:APO
Mailing Address - State:AE
Mailing Address - Zip Code:09031
Mailing Address - Country:DE
Mailing Address - Phone:09321-305-8416
Mailing Address - Fax:09321-305-8946
Practice Address - Street 1:USHC KITZINGEN
Practice Address - Street 2:UNIT 26124
Practice Address - City:APO
Practice Address - State:AE
Practice Address - Zip Code:09031
Practice Address - Country:DE
Practice Address - Phone:09321-305-8416
Practice Address - Fax:09321-305-8946
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-20
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO108956363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily