Provider Demographics
NPI:1497460588
Name:BAKER, CAILEN WATTENBARGER (DNP, PMHNP-BC, CNE)
Entity Type:Individual
Prefix:DR
First Name:CAILEN
Middle Name:WATTENBARGER
Last Name:BAKER
Suffix:
Gender:F
Credentials:DNP, PMHNP-BC, CNE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:520 SALLYS BRANCH RD E
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-7149
Mailing Address - Country:US
Mailing Address - Phone:606-401-3185
Mailing Address - Fax:
Practice Address - Street 1:520 SALLYS BRANCH RD E
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40741-7149
Practice Address - Country:US
Practice Address - Phone:606-401-3185
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-23
Last Update Date:2024-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018938363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty