Provider Demographics
NPI:1164730511
Name:BAKER, KAY LEA (RN)
Entity Type:Individual
Prefix:MRS
First Name:KAY
Middle Name:LEA
Last Name:BAKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:MS
Other - First Name:KAY
Other - Middle Name:LEA
Other - Last Name:BENTON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:2101 W ALTA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85041-5400
Mailing Address - Country:US
Mailing Address - Phone:602-304-3160
Mailing Address - Fax:
Practice Address - Street 1:2101 W ALTA VISTA RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85041-5400
Practice Address - Country:US
Practice Address - Phone:602-304-3160
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-20
Last Update Date:2010-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRN146088163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse