Provider Demographics
NPI:1295717148
Name:BAKER, SIDNEY (ARNP)
Entity type:Individual
Prefix:
First Name:SIDNEY
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 GORMAN HOLLOW RD
Mailing Address - Street 2:
Mailing Address - City:HAZARD
Mailing Address - State:KY
Mailing Address - Zip Code:41701-2315
Mailing Address - Country:US
Mailing Address - Phone:606-439-2361
Mailing Address - Fax:606-439-0870
Practice Address - Street 1:441 GORMAN HOLLOW RD
Practice Address - Street 2:
Practice Address - City:HAZARD
Practice Address - State:KY
Practice Address - Zip Code:41701-2315
Practice Address - Country:US
Practice Address - Phone:606-439-2361
Practice Address - Fax:606-439-0870
Is Sole Proprietor?:No
Enumeration Date:2005-11-16
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1053202163WC1500X
KY2927P363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
No163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY0281411Medicare PIN
KY0281506Medicare PIN
KY0281905Medicare PIN
KY0281605Medicare PIN
KY0059625Medicare PIN
P65111Medicare UPIN
KY0281806Medicare PIN
KY0281406Medicare PIN
KY0281511Medicare PIN
KY0281705Medicare PIN
KY0281910Medicare PIN