Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2200X | Nurse Practitioner - Adult Health | R0057523 | OK |
NPI | 1033169933 |
---|---|
Provider Name | Mrs. Kristy Renea Baker |
First Address | Oklahoma City, OK 73112-5556 |
Second Address | Weatherford, OK 73096-5437 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/05/2006 |
Last Update Date | 15/01/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200083240A | (05) | OK |
200083240B | (05) | OK |
Q70137 | (02) | OK |