Provider Demographics
NPI:1700993011
Name:BAKER, LYNETTE N (NP)
Entity Type:Individual
Prefix:
First Name:LYNETTE
Middle Name:N
Last Name:BAKER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6100 JACKSBORO HWY
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76135-3703
Mailing Address - Country:US
Mailing Address - Phone:817-237-4594
Mailing Address - Fax:817-237-3008
Practice Address - Street 1:6100 JACKSBORO HWY
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76135-3703
Practice Address - Country:US
Practice Address - Phone:817-237-4594
Practice Address - Fax:817-237-3008
Is Sole Proprietor?:No
Enumeration Date:2006-08-23
Last Update Date:2009-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11607363L00000X
TX559025363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3641817Medicaid
TX204693001Medicaid
TX204693002Medicaid
TX8L17192Medicare PIN
TN3641817Medicare PIN
TX204693002Medicaid
TX8K6566Medicare PIN
TN3641817Medicaid
TNQ56698Medicare UPIN