Provider Demographics
NPI:1669753216
Name:BAKER, KATHRYN REGAN HALL (PA)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:REGAN HALL
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9103 JEFFERSON HWY
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70809-2440
Mailing Address - Country:US
Mailing Address - Phone:225-927-1190
Mailing Address - Fax:225-706-0160
Practice Address - Street 1:9103 JEFFERSON HWY
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70809-2440
Practice Address - Country:US
Practice Address - Phone:225-927-1190
Practice Address - Fax:225-706-0160
Is Sole Proprietor?:No
Enumeration Date:2011-09-08
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPA200477363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical