Provider Demographics
NPI:1477801561
Name:BAKER, STEFANIE BROCK (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:STEFANIE
Middle Name:BROCK
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:STEFANIE
Other - Middle Name:RACHELLE
Other - Last Name:BROCK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5200 COMMERCE CROSSINGS DR FL 3
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40229-2182
Mailing Address - Country:US
Mailing Address - Phone:502-861-5278
Mailing Address - Fax:
Practice Address - Street 1:2040 HARRODSBURG RD STE 200
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1714
Practice Address - Country:US
Practice Address - Phone:859-899-7993
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-08-21
Last Update Date:2023-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA1749363A00000X
ARPA-576363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant