Provider Demographics
NPI:1679247522
Name:BAKER, JEFFREY PHILIP (NP-C)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:PHILIP
Last Name:BAKER
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4333 S 86TH ST STE 101
Mailing Address - Street 2:
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68526-9261
Mailing Address - Country:US
Mailing Address - Phone:402-483-6343
Mailing Address - Fax:402-483-8501
Practice Address - Street 1:4333 S 86TH ST STE 101
Practice Address - Street 2:
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68526-9261
Practice Address - Country:US
Practice Address - Phone:402-483-6343
Practice Address - Fax:402-483-8501
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE113695363LF0000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily