Provider Demographics
NPI:1255880779
Name:BAKER, KELLI J (CNP)
Entity type:Individual
Prefix:MRS
First Name:KELLI
Middle Name:J
Last Name:BAKER
Suffix:
Gender:F
Credentials:CNP
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Mailing Address - Street 1:4565 DRESSLER RD NW
Mailing Address - Street 2:SUITE #111
Mailing Address - City:CANTON
Mailing Address - State:OH
Mailing Address - Zip Code:44718-2549
Mailing Address - Country:US
Mailing Address - Phone:330-493-0013
Mailing Address - Fax:330-493-6973
Practice Address - Street 1:4565 DRESSLER RD NW
Practice Address - Street 2:SUITE #111
Practice Address - City:CANTON
Practice Address - State:OH
Practice Address - Zip Code:44718-2549
Practice Address - Country:US
Practice Address - Phone:330-493-0013
Practice Address - Fax:330-493-6973
Is Sole Proprietor?:No
Enumeration Date:2016-09-26
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OHF0916599363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner