Provider Demographics
NPI:1396248456
Name:BAKER, KAITLIN B (APRN-CNP)
Entity type:Individual
Prefix:MS
First Name:KAITLIN
Middle Name:B
Last Name:BAKER
Suffix:
Gender:F
Credentials:APRN-CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 DOE RUN
Mailing Address - Street 2:
Mailing Address - City:POWDERLY
Mailing Address - State:TX
Mailing Address - Zip Code:75473-4526
Mailing Address - Country:US
Mailing Address - Phone:903-517-3967
Mailing Address - Fax:
Practice Address - Street 1:1101 E MONROE AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4826
Practice Address - Country:US
Practice Address - Phone:918-426-7800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-15
Last Update Date:2023-10-11
Deactivation Date:2023-01-17
Deactivation Code:
Reactivation Date:2023-02-01
Provider Licenses
StateLicense IDTaxonomies
OK211531363LP0808X
TX930017163W00000X
TX1110251363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1110251OtherTEXAS BOARD OF NURSING - APRN-CNP
OK211531OtherOKLAHOMA BOARD OF NURSING - APRN-CNP
TX930017OtherREGISTERED NURSE