Healthcare Provider Details

I. General information

NPI: 1972227924
Provider Name (Legal Business Name): MISS KIMBERLY MICHELLE BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2022
Last Update Date: 10/03/2022
Certification Date: 10/03/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 BOULTIER ST APT 205
MONTGOMERY AL
36106-2230
US

IV. Provider business mailing address

2727 BOULTIER ST APT 205
MONTGOMERY AL
36106-2230
US

V. Phone/Fax

Practice location:
  • Phone: 205-370-4834
  • Fax:
Mailing address:
  • Phone: 205-370-4834
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RS0010X
TaxonomySports Medicine (Internal Medicine) Physician
License Number00000
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: