Provider Demographics
NPI:1205955424
Name:BAKER, AMANDA B (PA)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:B
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 BENTON AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37204-2303
Mailing Address - Country:US
Mailing Address - Phone:615-932-7629
Mailing Address - Fax:615-385-1842
Practice Address - Street 1:817 N CHARLOTTE ST
Practice Address - Street 2:
Practice Address - City:DICKSON
Practice Address - State:TN
Practice Address - Zip Code:37055-1008
Practice Address - Country:US
Practice Address - Phone:615-740-5900
Practice Address - Fax:615-446-2386
Is Sole Proprietor?:No
Enumeration Date:2007-03-28
Last Update Date:2024-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1455363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1514064Medicaid
TN1514064Medicaid