1578525663 NPI number — KIMBERLY RENE BAKER ARNP

Table of content: KIMBERLY RENE BAKER ARNP (NPI 1578525663)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578525663 NPI number — KIMBERLY RENE BAKER ARNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
KIMBERLY
Provider Middle Name:
RENE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
ARNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578525663
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2605 KENTUCKY AVE
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
PADUCAH
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
42003-3800
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
270-415-7653
Provider Business Mailing Address Fax Number:
270-575-8359

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2603 KENTUCKY AVE
Provider Second Line Business Practice Location Address:
SUITE 201
Provider Business Practice Location Address City Name:
PADUCAH
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
42003-3814
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
270-443-1220
Provider Business Practice Location Address Fax Number:
270-443-0023
Provider Enumeration Date:
04/04/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363L00000X , with the licence number:  1037862 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 7100119460 , issued by the state of ( KY ) . This identifiers is of the category "MEDICAID".




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