Provider Demographics
NPI:1891354114
Name:BAKER, MICHAEL JOHN (NP)
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:JOHN
Last Name:BAKER
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9066 FIELD BROOK CIR N
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36695-9332
Mailing Address - Country:US
Mailing Address - Phone:251-370-3007
Mailing Address - Fax:
Practice Address - Street 1:4502 LT EUGENE J MAJURE DR
Practice Address - Street 2:
Practice Address - City:PASCAGOULA
Practice Address - State:MS
Practice Address - Zip Code:39581-5305
Practice Address - Country:US
Practice Address - Phone:228-696-9224
Practice Address - Fax:228-696-9228
Is Sole Proprietor?:No
Enumeration Date:2019-06-11
Last Update Date:2022-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903366363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS02125328Medicaid