Provider Demographics
NPI:1093376675
Name:BAKER, KATHRYN GRACE (DNP, FNP-C)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:GRACE
Last Name:BAKER
Suffix:
Gender:F
Credentials:DNP, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:509 HAMMILL LN
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89511-1004
Mailing Address - Country:US
Mailing Address - Phone:774-322-0300
Mailing Address - Fax:775-332-0311
Practice Address - Street 1:509 HAMMILL LN
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89511-1004
Practice Address - Country:US
Practice Address - Phone:774-322-0300
Practice Address - Fax:775-332-0311
Is Sole Proprietor?:No
Enumeration Date:2019-06-25
Last Update Date:2019-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV821991363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily