Provider Demographics
NPI:1760119341
Name:BAKER, RHONDA CAROL
Entity Type:Individual
Prefix:
First Name:RHONDA
Middle Name:CAROL
Last Name:BAKER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:989 HIGHWAY 32 E
Mailing Address - Street 2:
Mailing Address - City:HOULKA
Mailing Address - State:MS
Mailing Address - Zip Code:38850-8206
Mailing Address - Country:US
Mailing Address - Phone:662-760-1697
Mailing Address - Fax:
Practice Address - Street 1:989 HIGHWAY 32 E
Practice Address - Street 2:
Practice Address - City:HOULKA
Practice Address - State:MS
Practice Address - Zip Code:38850-8206
Practice Address - Country:US
Practice Address - Phone:662-760-1697
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-04
Last Update Date:2022-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS905337363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS905337OtherLNP LICENSE NUMBER