Basic Information
| Provider Information | |||||||||
| NPI: | 1346661402 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | CAGNEY | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | RN-BSN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 470 HULON LANE | ||||||||
| Address2: | ATTN: VP OF REVENUE CYCLE | ||||||||
| City: | WEST COLUMBIA | ||||||||
| State: | SC | ||||||||
| PostalCode: | 291694810 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8037912000 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 338 E COLUMBIA AVE | ||||||||
| Address2: | |||||||||
| City: | BATESBURG LEESVILLE | ||||||||
| State: | SC | ||||||||
| PostalCode: | 290709285 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8036040066 | ||||||||
| FaxNumber: | 8036049924 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/17/2013 | ||||||||
| LastUpdateDate: | 09/30/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/30/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 24193 | SC | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 163WS0200X | 205622 | SC | N | Nursing Service Providers | Registered Nurse | School |
No ID Information.