Provider Demographics
NPI:1033947171
Name:BAKER, KELLI DAIL (FNP, RN)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:DAIL
Last Name:BAKER
Suffix:
Gender:F
Credentials:FNP, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 MILL CREEK RD
Mailing Address - Street 2:
Mailing Address - City:MEHERRIN
Mailing Address - State:VA
Mailing Address - Zip Code:23954-3186
Mailing Address - Country:US
Mailing Address - Phone:434-547-3326
Mailing Address - Fax:
Practice Address - Street 1:969 MILL CREEK RD
Practice Address - Street 2:
Practice Address - City:MEHERRIN
Practice Address - State:VA
Practice Address - Zip Code:23954-3186
Practice Address - Country:US
Practice Address - Phone:434-547-3326
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-22
Last Update Date:2025-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001247035163W00000X
VA0024191552363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty