Provider Demographics
NPI:1043201445
Name:BAKER, KATHY DAVIS (BSN/CPNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHY
Middle Name:DAVIS
Last Name:BAKER
Suffix:
Gender:F
Credentials:BSN/CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1177
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42102-1177
Mailing Address - Country:US
Mailing Address - Phone:270-783-3573
Mailing Address - Fax:
Practice Address - Street 1:615 7TH AVE
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101-6921
Practice Address - Country:US
Practice Address - Phone:270-783-3573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-11-03
Last Update Date:2019-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3000397363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY3000397OtherKENTUCKY BOARD OF NURSING
KY78009495Medicaid