MEDICARE: MRS. MELISSA J BAKER APRN

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	3004685	KY

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

General Provider Information

NPI Number	:	1861443384
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. MELISSA J BAKER APRN

Provider Business Mailing Address
First Line	:	201 PARK ST
Second Line	:
City	:	BOWLING GREEN
State	:	KY
Zip	:	42101-1708
Country	:	US
Telephone Number	:	270-781-5111
Fax Number	:

Provider Business Practice Location Address
First Line	:	100 PARK PL STE 6
Second Line	:
City	:	BROWNSVILLE
State	:	KY
Zip	:	42210-9036
Country	:	US
Telephone Number	:	270-597-8353
Fax Number	:	270-937-3120

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

Provider Enumeration Date	:	05/12/2006
Last Update Date	:	06/10/2019

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