Provider Demographics
NPI:1568691566
Name:BAKER, DIANA C (EDD, FNP, CNS)
Entity Type:Individual
Prefix:DR
First Name:DIANA
Middle Name:C
Last Name:BAKER
Suffix:
Gender:F
Credentials:EDD, FNP, CNS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5179 NORMANDY LN
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38117-2850
Mailing Address - Country:US
Mailing Address - Phone:901-682-4028
Mailing Address - Fax:901-682-4028
Practice Address - Street 1:5179 NORMANDY LN
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38117-2850
Practice Address - Country:US
Practice Address - Phone:901-682-4028
Practice Address - Fax:901-682-4028
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-11
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005042364SP0809X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult