Healthcare Provider Details

I. General information

NPI: 1285224568
Provider Name (Legal Business Name): CAROLINE BAKER CRNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/21/2021
Last Update Date: 08/17/2022
Certification Date: 08/17/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1813 6TH AVE S
BIRMINGHAM AL
35233-1920
US

IV. Provider business mailing address

1813 6TH AVE S
BIRMINGHAM AL
35233-1920
US

V. Phone/Fax

Practice location:
  • Phone: 205-934-3438
  • Fax:
Mailing address:
  • Phone: 205-934-6500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number1-134085
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: