Provider Demographics
NPI:1013550482
Name:BAKER, NICOLE LYNNE (NP-C)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:LYNNE
Last Name:BAKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:LYNNE
Other - Last Name:GALLANT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 802843
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64180-2843
Mailing Address - Country:US
Mailing Address - Phone:417-730-6430
Mailing Address - Fax:417-269-7567
Practice Address - Street 1:3203 E OLD STONE AVE
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MO
Practice Address - Zip Code:65619-9620
Practice Address - Country:US
Practice Address - Phone:417-269-1910
Practice Address - Fax:417-269-1916
Is Sole Proprietor?:No
Enumeration Date:2019-10-17
Last Update Date:2023-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019039808363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO2009028096OtherRN LICENSE
MO2019039808OtherNP LICENSE