Provider Demographics
NPI:1477323640
Name:BAKER, MARKEISHA
Entity Type:Individual
Prefix:
First Name:MARKEISHA
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 1:31330 HIGHWAY 22 STE 101
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:LA
Mailing Address - Zip Code:70462-7415
Mailing Address - Country:US
Mailing Address - Phone:225-294-7227
Mailing Address - Fax:225-294-7767
Practice Address - Street 1:31330 HIGHWAY 22 STE 101
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:LA
Practice Address - Zip Code:70462-7415
Practice Address - Country:US
Practice Address - Phone:225-294-7227
Practice Address - Fax:225-294-7767
Is Sole Proprietor?:Yes
Enumeration Date:2024-01-08
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator