Individual provider Active NPI

Kyle James Baldock, RN, APRN, CPNP-PC

  • Pediatric Nurse Practitioner
  • Nacogdoches, TX
National Provider Identifier
1689519258
Registry record updated Apr 21, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pediatric Nurse PractitionerTaxonomy code 363LP0200X
License
1001255 Issued in TX
Practice address
625 Russell Blvd
Nacogdoches, TX 75965-1247
Phone
(936) 305-5050
Fax
(936) 305-5151
NPI assigned
Apr 21, 2026
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Apr 21, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pediatric Nurse Practitioner 363LP0200X 1001255 TX Primary

Addresses

Primary practice location

625 Russell Blvd
Nacogdoches, TX 75965-1247

Mailing address

636 E Oak LN
Nacogdoches, TX 75961-4707
Phone (936) 652-4832

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
1001255TXMDPediatric Nurse Practitioner

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1776729600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1776729600000",
    "number": "1689519258",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "636 E OAK LN",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759614707",
            "telephone_number": "936-652-4832"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "625 RUSSELL BLVD",
            "city": "NACOGDOCHES",
            "state": "TX",
            "postal_code": "759651247",
            "telephone_number": "936-305-5050",
            "fax_number": "936-305-5151"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BALDOCK",
        "first_name": "KYLE",
        "middle_name": "JAMES",
        "credential": "RN, APRN, CPNP-PC",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2026-04-21",
        "last_updated": "2026-04-21",
        "certification_date": "2026-04-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "TX",
            "license": "1001255",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Nacogdoches, TX

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 21, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.