Basic Information
| Provider Information | |||||||||
| NPI: | 1144245713 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | BARBARA | ||||||||
| MiddleName: | JEAN | ||||||||
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| Credential: | FNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 60447 | ||||||||
| Address2: | |||||||||
| City: | CHARLOTTE | ||||||||
| State: | NC | ||||||||
| PostalCode: | 282600447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365953699 | ||||||||
| FaxNumber: | 3365953193 | ||||||||
| Practice Location | |||||||||
| Address1: | 2800 DARROW RD | ||||||||
| Address2: | |||||||||
| City: | WALKERTOWN | ||||||||
| State: | NC | ||||||||
| PostalCode: | 270519206 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3365953699 | ||||||||
| FaxNumber: | 3365953193 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/13/2006 | ||||||||
| LastUpdateDate: | 10/26/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/06/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | ARNP9339899 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | F331788-1 | NY | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363L00000X | 5010223 | NC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner |
ID Information
| ID | Type | State | Issuer | Description | 000490156003 | 01 | NY | BLUESHIELD NE NY | OTHER | 010554400 | 05 | FL | MEDICAID |