Basic Information
| Provider Information | |||||||||
| NPI: | 1861503757 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | VANESSA | ||||||||
| MiddleName: | Y | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | FNP, WHNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3200 N ASHLEY ST STE C | ||||||||
| Address2: | |||||||||
| City: | VALDOSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316025911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2296719100 | ||||||||
| FaxNumber: | 2296719101 | ||||||||
| Practice Location | |||||||||
| Address1: | 3200 N ASHLEY ST STE C | ||||||||
| Address2: | |||||||||
| City: | VALDOSTA | ||||||||
| State: | GA | ||||||||
| PostalCode: | 316025911 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2296719100 | ||||||||
| FaxNumber: | 2296719101 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/31/2006 | ||||||||
| LastUpdateDate: | 05/01/2017 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
| IsOrganizationSubpart: | |||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | RN072455 | GA | N | Nursing Service Providers | Registered Nurse | 363LX0001X | RN072455 | GA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Obstetrics & Gynecology | 363LF0000X | RN072455 | GA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 000803481A | 05 | GA | MEDICAID |