Provider Demographics
NPI:1861503757
Name:BAKER, VANESSA Y (FNP, WHNP)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:Y
Last Name:BAKER
Suffix:
Gender:F
Credentials:FNP, WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 N ASHLEY ST STE C
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602-5911
Mailing Address - Country:US
Mailing Address - Phone:229-671-9100
Mailing Address - Fax:229-671-9101
Practice Address - Street 1:241 LAKES BLVD
Practice Address - Street 2:
Practice Address - City:LAKE PARK
Practice Address - State:GA
Practice Address - Zip Code:31636-5007
Practice Address - Country:US
Practice Address - Phone:229-433-5843
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN072455163W00000X, 363LX0001X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No363LX0001XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA000803481AMedicaid
GAS95196Medicare UPIN
GA50BBDFWMedicare PIN