Provider Demographics
NPI:1518211853
Name:BAKER SCHOOL BASED HEALTH CLINIC
Entity Type:Organization
Organization Name:BAKER SCHOOL BASED HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER/FNP
Authorized Official - Prefix:
Authorized Official - First Name:LATOYA
Authorized Official - Middle Name:
Authorized Official - Last Name:LEONARD-HUGHES
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:225-978-5909
Mailing Address - Street 1:PO BOX 149
Mailing Address - Street 2:
Mailing Address - City:GROSSE TETE
Mailing Address - State:LA
Mailing Address - Zip Code:70740-0149
Mailing Address - Country:US
Mailing Address - Phone:225-648-3433
Mailing Address - Fax:877-580-7773
Practice Address - Street 1:3033 RAY WEILAND DR # B
Practice Address - Street 2:
Practice Address - City:BAKER
Practice Address - State:LA
Practice Address - Zip Code:70714-3251
Practice Address - Country:US
Practice Address - Phone:225-978-5909
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-08
Last Update Date:2012-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1454711Medicaid
LA1304450Medicaid
LA3A043Medicare UPIN
LA1454711Medicaid