Provider Demographics
NPI:1538835830
Name:BAKER, KATHY
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:104 COOKS RUN DR
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:WV
Mailing Address - Zip Code:26374-8100
Mailing Address - Country:US
Mailing Address - Phone:304-669-5504
Mailing Address - Fax:
Practice Address - Street 1:104 COOKS RUN DR
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:WV
Practice Address - Zip Code:26374-8100
Practice Address - Country:US
Practice Address - Phone:304-669-5504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-18
Last Update Date:2021-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant