Provider Demographics
NPI:1255531711
Name:BAKER, MELISSA R (NP-C)
Entity type:Individual
Prefix:MRS
First Name:MELISSA
Middle Name:R
Last Name:BAKER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2315 GREEN VALLEY RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEW ALBANY
Mailing Address - State:IN
Mailing Address - Zip Code:47150-4649
Mailing Address - Country:US
Mailing Address - Phone:812-945-2100
Mailing Address - Fax:812-945-9495
Practice Address - Street 1:2315 GREEN VALLEY RD
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW ALBANY
Practice Address - State:IN
Practice Address - Zip Code:47150-4649
Practice Address - Country:US
Practice Address - Phone:812-945-2100
Practice Address - Fax:812-945-9495
Is Sole Proprietor?:No
Enumeration Date:2007-07-23
Last Update Date:2016-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002448A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200279060Medicaid
P00434558OtherIN RAILROAD MEDICARE PIN
KY000000536270OtherANTHEM PROV#
IN185790DMedicare PIN