Provider Demographics
NPI:1720040157
Name:BAKER, FRED POWELL JR (RN-PMHNP-BC)
Entity Type:Individual
Prefix:MR
First Name:FRED
Middle Name:POWELL
Last Name:BAKER
Suffix:JR
Gender:M
Credentials:RN-PMHNP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:7901 METROPOLIS DR
Mailing Address - Street 2:VA OUTPATIENT CLINIC
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78744-3111
Mailing Address - Country:US
Mailing Address - Phone:512-823-4342
Mailing Address - Fax:
Practice Address - Street 1:7901 METROPOLIS DR # 78744
Practice Address - Street 2:VA OUTPATIENT CLINIC
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78744-3111
Practice Address - Country:US
Practice Address - Phone:512-823-4342
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-04-03
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TX529711363LP0808X
TXRN LIC. NO. 529711364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health