Provider Demographics
NPI:1245567965
Name:BAKER, CLIFTON RICHARD (NP)
Entity Type:Individual
Prefix:
First Name:CLIFTON
Middle Name:RICHARD
Last Name:BAKER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2304 LEIGHTON CT
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-3020
Mailing Address - Country:US
Mailing Address - Phone:804-938-0683
Mailing Address - Fax:
Practice Address - Street 1:2304 LEIGHTON CT
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-3020
Practice Address - Country:US
Practice Address - Phone:804-562-2997
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-17
Last Update Date:2021-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001203890163W00000X
VA0024180217363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse