Provider Demographics
NPI:1366847485
Name:BAKER, CHERYL BETH (APRN)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:BETH
Last Name:BAKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 MADISON AVE
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41011-3313
Mailing Address - Country:US
Mailing Address - Phone:859-655-6100
Mailing Address - Fax:859-655-6148
Practice Address - Street 1:120 PROGRESS WAY
Practice Address - Street 2:
Practice Address - City:OWENTON
Practice Address - State:KY
Practice Address - Zip Code:40359-6032
Practice Address - Country:US
Practice Address - Phone:844-655-6100
Practice Address - Fax:502-484-2102
Is Sole Proprietor?:No
Enumeration Date:2014-10-31
Last Update Date:2018-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005364A363LF0000X
KY3009028363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100391490Medicaid
IN201305890Medicaid
ININ2342001Medicare PIN
KYK200160Medicare PIN