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NPI Code Detail

MEDICARE: KACEY BAKER RBT

MEDICARE: KACEY BAKER RBT
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
1106S00000XBehavior TechnicianRBT-24-342274IN

General Provider Information

NPI Number : 1881408037
Entity Type Code : Individual
Provider Name (Legal Business Name) : KACEY BAKER RBT
Provider Business Mailing Address
First Line : 3006 EASTPOINT PKWY
Second Line :
City : LOUISVILLE
State : KY
Zip : 40223-4185
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5201 E VIRGINIA ST
Second Line :
City : EVANSVILLE
State : IN
Zip : 47715-2656
Country : US
Telephone Number : 502-795-0773
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2025
Last Update Date : 02/06/2025

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