Provider Demographics
NPI:1386233260
Name:BAKER, MYCAH C (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:MYCAH
Middle Name:C
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Mailing Address - Street 1:5150 N BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37918-2342
Mailing Address - Country:US
Mailing Address - Phone:865-549-5111
Mailing Address - Fax:865-521-1370
Practice Address - Street 1:5150 N BROADWAY ST
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37918-2342
Practice Address - Country:US
Practice Address - Phone:865-549-5111
Practice Address - Fax:865-521-1370
Is Sole Proprietor?:No
Enumeration Date:2021-01-14
Last Update Date:2023-05-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TN4044363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant