Basic Information
| Provider Information | |||||||||
| NPI: | 1659673721 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | BAKER | ||||||||
| FirstName: | KERI | ||||||||
| MiddleName: | A | ||||||||
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| Credential: | NP-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 776351 | ||||||||
| Address2: | |||||||||
| City: | CHICAGO | ||||||||
| State: | IL | ||||||||
| PostalCode: | 606776351 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5025889490 | ||||||||
| FaxNumber: | 5022725116 | ||||||||
| Practice Location | |||||||||
| Address1: | 2051 CLEVIDENCE BLVD | ||||||||
| Address2: | STE. 1 | ||||||||
| City: | CLARKSVILLE | ||||||||
| State: | IN | ||||||||
| PostalCode: | 471292278 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8122809145 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 11/23/2010 | ||||||||
| LastUpdateDate: | 01/12/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 01/12/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 28148407A | IN | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 363LF0000X | 71003464 | IN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.