Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 176B00000X | Midwife | 99394 | TX |
NPI | 1073864781 |
---|---|
Provider Name | Kiesha J Baker |
First Address | Dallas, TX 75246-1014 |
Second Address | Dallas, TX 75208-5703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/09/2012 |
Last Update Date | 18/12/2019 |