Provider Demographics
NPI:1326708421
Name:BAKER, AMANDA LEE (ARNP FNP)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:BAKER
Suffix:
Gender:F
Credentials:ARNP FNP
Other - Prefix:
Other - First Name:AMANDA
Other - Middle Name:L
Other - Last Name:KNIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:ARNP, FNP
Mailing Address - Street 1:PO BOX 317
Mailing Address - Street 2:
Mailing Address - City:ELK
Mailing Address - State:WA
Mailing Address - Zip Code:99009-0317
Mailing Address - Country:US
Mailing Address - Phone:509-435-1203
Mailing Address - Fax:
Practice Address - Street 1:23 E CRAWFORD ST
Practice Address - Street 2:
Practice Address - City:DEER PARK
Practice Address - State:WA
Practice Address - Zip Code:99006-5432
Practice Address - Country:US
Practice Address - Phone:509-485-4663
Practice Address - Fax:509-399-7883
Is Sole Proprietor?:No
Enumeration Date:2021-12-30
Last Update Date:2022-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAF12210889363LF0000X
WAAP61258993363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily