Provider Demographics
NPI:1669418497
Name:BAKER, NEVIN E (CRNA)
Entity type:Individual
Prefix:MR
First Name:NEVIN
Middle Name:E
Last Name:BAKER
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST
Mailing Address - Street 2:SUITE 800
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1434
Mailing Address - Country:US
Mailing Address - Phone:502-361-6617
Mailing Address - Fax:502-361-6637
Practice Address - Street 1:1850 BLUEGRASS AVE
Practice Address - Street 2:ANESTHESIA DEPARTMENT
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40215-1161
Practice Address - Country:US
Practice Address - Phone:502-367-3360
Practice Address - Fax:502-367-3365
Is Sole Proprietor?:No
Enumeration Date:2006-06-21
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004780367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000945233 (KOHMG)OtherANTHEM
KY051620OtherKENTUCKY
IN201183190 (KOHMG)Medicaid
KY74012204 (KOHMG)Medicaid
KYK022014 (KOHMG)Medicare PIN
KY74012204 (KOHMG)Medicaid
KYP27382Medicare UPIN