Provider Demographics
NPI:1013088947
Name:BAKER, BRENDA JOAN (MD)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:JOAN
Last Name:BAKER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 517
Mailing Address - Street 2:
Mailing Address - City:NEON
Mailing Address - State:KY
Mailing Address - Zip Code:41840
Mailing Address - Country:US
Mailing Address - Phone:606-832-0192
Mailing Address - Fax:606-832-0194
Practice Address - Street 1:BUILDING 37
Practice Address - Street 2:HIGHWAY 343
Practice Address - City:NEON
Practice Address - State:KY
Practice Address - Zip Code:41840
Practice Address - Country:US
Practice Address - Phone:606-832-0192
Practice Address - Fax:606-832-0194
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2018-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY29340207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
163979300OtherOWCP
2607OtherCHA
000000050221OtherBCBS
5946030OtherAETNA
KY64293400Medicaid
010401700OtherFEDERAL BLACK LUNG
000000050221OtherBCBS
F48808Medicare UPIN
010401700OtherFEDERAL BLACK LUNG