MEDICARE: CANDICE J. BAKER F.N.P.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	066060	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	31726018	OTHER	MO	BCBS SERVICING PROVIDER#

General Provider Information

NPI Number	:	1841288834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CANDICE J. BAKER F.N.P.

Provider Business Mailing Address
First Line	:	1602 N 2ND ST
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-1192
Country	:	US
Telephone Number	:	660-885-8171
Fax Number	:

Provider Business Practice Location Address
First Line	:	1602 N 2ND ST
Second Line	:
City	:	CLINTON
State	:	MO
Zip	:	64735-1192
Country	:	US
Telephone Number	:	660-885-8171
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/12/2005
Last Update Date	:	08/25/2014

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