Basic Information
| Provider Information | |||||||||
| NPI: | 1073106258 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | CRYSTAL | ||||||||
| MiddleName: | LEIGH | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 101 CLINIC DR | ||||||||
| Address2: | |||||||||
| City: | TARBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278861935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2528232105 | ||||||||
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| Practice Location | |||||||||
| Address1: | 101 CLINIC DR | ||||||||
| Address2: | |||||||||
| City: | TARBORO | ||||||||
| State: | NC | ||||||||
| PostalCode: | 278861935 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2528232105 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/18/2021 | ||||||||
| LastUpdateDate: | 03/11/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 261459 | NC | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 208800000X | 5014140 | NC | Y | Allopathic & Osteopathic Physicians | Urology |
No ID Information.