Provider Demographics
NPI:1386183879
Name:BAKER, KARA
Entity Type:Individual
Prefix:MS
First Name:KARA
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:316 WARRENTON PL
Mailing Address - Street 2:
Mailing Address - City:BROOKLET
Mailing Address - State:GA
Mailing Address - Zip Code:30415-0138
Mailing Address - Country:US
Mailing Address - Phone:912-601-7678
Mailing Address - Fax:
Practice Address - Street 1:159 WEST RAILROAD STREET
Practice Address - Street 2:SUITE A
Practice Address - City:PEMBROKE
Practice Address - State:GA
Practice Address - Zip Code:31321-3431
Practice Address - Country:US
Practice Address - Phone:912-653-2897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-02-16
Last Update Date:2023-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN209364363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily