Provider Demographics
NPI:1326431024
Name:BAKER, KERRIE HOGIN (FNP)
Entity Type:Individual
Prefix:
First Name:KERRIE
Middle Name:HOGIN
Last Name:BAKER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2413 MEMORIAL PKWY
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:TX
Mailing Address - Zip Code:78374-3209
Mailing Address - Country:US
Mailing Address - Phone:361-643-4546
Mailing Address - Fax:
Practice Address - Street 1:2413 MEMORIAL PKWY
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:TX
Practice Address - Zip Code:78374-3209
Practice Address - Country:US
Practice Address - Phone:361-643-4546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-03-05
Last Update Date:2022-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP131958363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN6039719OtherBCBS TN
TNQ014916Medicaid
TN103I500902Medicare PIN