Provider Demographics
NPI:1114957370
Name:BAKER, KENDA GALE (PA)
Entity Type:Individual
Prefix:
First Name:KENDA
Middle Name:GALE
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA
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 1537
Mailing Address - Street 2:
Mailing Address - City:STILLWATER
Mailing Address - State:OK
Mailing Address - Zip Code:74076-1537
Mailing Address - Country:US
Mailing Address - Phone:405-372-7575
Mailing Address - Fax:405-533-1093
Practice Address - Street 1:1329 S SANGRE RD
Practice Address - Street 2:
Practice Address - City:STILLWATER
Practice Address - State:OK
Practice Address - Zip Code:74074-1854
Practice Address - Country:US
Practice Address - Phone:405-372-7575
Practice Address - Fax:405-533-1093
Is Sole Proprietor?:No
Enumeration Date:2006-07-04
Last Update Date:2016-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK635363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical