Provider Demographics
NPI:1518997170
Name:BAKER, HEATHER L (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HEATHER
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:HEATHER
Other - Middle Name:
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5400 FRANTZ RD
Mailing Address - Street 2:STE 250
Mailing Address - City:DUBLIN
Mailing Address - State:OH
Mailing Address - Zip Code:43016-6102
Mailing Address - Country:US
Mailing Address - Phone:614-544-6382
Mailing Address - Fax:614-544-6370
Practice Address - Street 1:9485 STRAWSER ST
Practice Address - Street 2:
Practice Address - City:ORIENT
Practice Address - State:OH
Practice Address - Zip Code:43146-9328
Practice Address - Country:US
Practice Address - Phone:614-277-1907
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-03
Last Update Date:2018-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50-00-2101363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHBAPA22221Medicare UPIN
OHQ04869Medicare UPIN