Provider Demographics
NPI:1205080504
Name:BAKER, LACIE ALISON (PA-C)
Entity type:Individual
Prefix:
First Name:LACIE
Middle Name:ALISON
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:LACIE
Other - Middle Name:ALISON
Other - Last Name:WILES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2400 PATTERSON ST.
Mailing Address - Street 2:STE. 200
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-1562
Mailing Address - Country:US
Mailing Address - Phone:615-342-6300
Mailing Address - Fax:615-342-6350
Practice Address - Street 1:1321 MURFREESBORO RD.
Practice Address - Street 2:STE. 510
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37217-2626
Practice Address - Country:US
Practice Address - Phone:615-366-8890
Practice Address - Fax:615-366-3379
Is Sole Proprietor?:No
Enumeration Date:2008-11-13
Last Update Date:2010-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1665363A00000X
TN1684363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4266963OtherBCBS
TN4266994OtherBCBS
TN4266994OtherBCBS