Provider Demographics
NPI:1821542564
Name:BAKER, KATELYN M (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KATELYN
Middle Name:M
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:MISS
Other - First Name:KATELYN
Other - Middle Name:M
Other - Last Name:STRITTMATHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:403 MARVEL CT
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-4053
Mailing Address - Country:US
Mailing Address - Phone:410-819-8867
Mailing Address - Fax:410-819-8873
Practice Address - Street 1:403 MARVEL CT
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601
Practice Address - Country:US
Practice Address - Phone:410-819-8867
Practice Address - Fax:410-819-8873
Is Sole Proprietor?:No
Enumeration Date:2016-08-11
Last Update Date:2018-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0006738363AM0700X
IN10002090A363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDC0006738OtherLICENSE