Provider Demographics
NPI:1043663396
Name:BAKER, AMY (APRN-C)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:APRN-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3211 S IOWA ST STE 100
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66046-5238
Mailing Address - Country:US
Mailing Address - Phone:785-505-5475
Mailing Address - Fax:785-505-5326
Practice Address - Street 1:3211 S IOWA ST STE 100
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66046-5238
Practice Address - Country:US
Practice Address - Phone:785-505-5475
Practice Address - Fax:785-505-5326
Is Sole Proprietor?:No
Enumeration Date:2016-07-21
Last Update Date:2020-11-24
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KS77301363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS11028309Medicare PIN