Provider Demographics
NPI:1881311512
Name:BATEMAN, KALLIE (FNP-BC)
Entity type:Individual
Prefix:
First Name:KALLIE
Middle Name:
Last Name:BATEMAN
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4742 FARM ROAD 2140
Mailing Address - Street 2:
Mailing Address - City:EXETER
Mailing Address - State:MO
Mailing Address - Zip Code:65647-7260
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4742 FARM ROAD 2140
Practice Address - Street 2:
Practice Address - City:EXETER
Practice Address - State:MO
Practice Address - Zip Code:65647-7260
Practice Address - Country:US
Practice Address - Phone:417-342-3598
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-24
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018002456163W00000X
MO2023007998363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner