Provider Demographics
NPI:1932631058
Name:BAKER, KIRSTEN (PA)
Entity Type:Individual
Prefix:
First Name:KIRSTEN
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:KIRSTEN
Other - Middle Name:ELAINE
Other - Last Name:BROWN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:427 STONEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78216-1625
Mailing Address - Country:US
Mailing Address - Phone:210-241-6362
Mailing Address - Fax:
Practice Address - Street 1:1950 HUEBNER ROAD
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78240
Practice Address - Country:US
Practice Address - Phone:210-334-0012
Practice Address - Fax:210-334-0196
Is Sole Proprietor?:Yes
Enumeration Date:2017-03-29
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA12622363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA12622OtherPA-C TEXAS STATE LICENSE