Provider Demographics
NPI:1518950047
Name:BAKER, DARCIE A (PA C)
Entity Type:Individual
Prefix:
First Name:DARCIE
Middle Name:A
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 E STATE HIGHWAY 243
Mailing Address - Street 2:
Mailing Address - City:CANTON
Mailing Address - State:TX
Mailing Address - Zip Code:75103-2409
Mailing Address - Country:US
Mailing Address - Phone:903-567-4784
Mailing Address - Fax:
Practice Address - Street 1:406 E STATE HIGHWAY 243
Practice Address - Street 2:
Practice Address - City:CANTON
Practice Address - State:TX
Practice Address - Zip Code:75103-2409
Practice Address - Country:US
Practice Address - Phone:903-567-4784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2021-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA10004351363A00000X
TXPA14793363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMA0876221OtherDEA #
WAMA0876221OtherDEA #
WAGAB33943Medicare PIN
P68819Medicare UPIN