Provider Demographics
NPI:1780671651
Name:BAKER, CHRISTY QUIRE (FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTY
Middle Name:QUIRE
Last Name:BAKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:
Other - Last Name:QUIRE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1169 EASTERN PKWY STE 431
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1435
Mailing Address - Country:US
Mailing Address - Phone:502-953-4783
Mailing Address - Fax:502-361-9229
Practice Address - Street 1:1169 EASTERN PKWY STE 431
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1435
Practice Address - Country:US
Practice Address - Phone:502-361-3909
Practice Address - Fax:502-361-9229
Is Sole Proprietor?:No
Enumeration Date:2005-10-05
Last Update Date:2020-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003085363LF0000X
KY3085P363L00000X, 207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000196210OtherANTHEM
KY2437387000OtherPASSPORT ADVANTAGE
KY78004496Medicaid
IN200351040Medicaid
KY1125464OtherPASSPORT
KY78004496Medicaid
KY000000196210OtherANTHEM
KYP28684Medicare UPIN