Provider Demographics
NPI:1881426492
Name:BAYNES, KALEB ANTHONY
Entity type:Individual
Prefix:
First Name:KALEB
Middle Name:ANTHONY
Last Name:BAYNES
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 W ADAMS
Mailing Address - Street 2:
Mailing Address - City:CARLTON
Mailing Address - State:OR
Mailing Address - Zip Code:97111-9613
Mailing Address - Country:US
Mailing Address - Phone:503-915-7437
Mailing Address - Fax:
Practice Address - Street 1:114 W ADAMS
Practice Address - Street 2:
Practice Address - City:CARLTON
Practice Address - State:OR
Practice Address - Zip Code:97111-9613
Practice Address - Country:US
Practice Address - Phone:503-915-7437
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care