Provider Demographics
NPI:1568403616
Name:BAKER, DOROTHY R (RN MSN ARNP)
Entity Type:Individual
Prefix:MS
First Name:DOROTHY
Middle Name:R
Last Name:BAKER
Suffix:
Gender:F
Credentials:RN MSN ARNP
Other - Prefix:
Other - First Name:DOROTHY
Other - Middle Name:
Other - Last Name:BRADY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 635283
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-5283
Mailing Address - Country:US
Mailing Address - Phone:859-384-2660
Mailing Address - Fax:859-384-5248
Practice Address - Street 1:8726 US HWY 42
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042
Practice Address - Country:US
Practice Address - Phone:859-384-2660
Practice Address - Fax:859-384-5248
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH221135163W00000X
KY1058398163W00000X
OHAPRN.CNP.07753363LF0000X
KY2539P363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYP00374145OtherRAILROAD MEDICARE
KY78004041Medicaid
OH2544670Medicaid
KY0403749Medicare PIN
OH2544670Medicaid
KYS72341Medicare UPIN