Provider Demographics
NPI:1750957338
Name:BAKER, AMANDA LEE (FNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:LEE
Last Name:BAKER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4225 BENT GRASS DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28312-8719
Mailing Address - Country:US
Mailing Address - Phone:910-491-9418
Mailing Address - Fax:
Practice Address - Street 1:1074 SOUTHERN AVE
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28306-1766
Practice Address - Country:US
Practice Address - Phone:910-491-4530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-03
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5014509363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily