Provider Demographics
NPI:1134172232
Name:BAKER, JENNIFER A (APRN)
Entity type:Individual
Prefix:MRS
First Name:JENNIFER
Middle Name:A
Last Name:BAKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 TOWER CIRCLE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503
Mailing Address - Country:US
Mailing Address - Phone:606-772-3376
Mailing Address - Fax:
Practice Address - Street 1:85 TOWER CIRCLE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503
Practice Address - Country:US
Practice Address - Phone:606-772-3376
Practice Address - Fax:606-677-0335
Is Sole Proprietor?:No
Enumeration Date:2006-05-18
Last Update Date:2014-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041336577363LF0000X
KY5583P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILP00326397OtherRAILROAD MEDICARE
ILP00326397OtherRAILROAD MEDICARE
ILQ70902Medicare UPIN