Provider Demographics
NPI:1205523347
Name:BAKER, KIRSTIN MONEAKA (APRN, CNP, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:KIRSTIN
Middle Name:MONEAKA
Last Name:BAKER
Suffix:
Gender:F
Credentials:APRN, CNP, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1030 ORKLA DR
Mailing Address - Street 2:
Mailing Address - City:GOLDEN VALLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55427-4440
Mailing Address - Country:US
Mailing Address - Phone:612-443-7424
Mailing Address - Fax:
Practice Address - Street 1:1030 ORKLA DR
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:MN
Practice Address - Zip Code:55427-4440
Practice Address - Country:US
Practice Address - Phone:612-443-7424
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-19
Last Update Date:2023-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN10115363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health