Healthcare Provider Details

I. General information

NPI: 1518615756
Provider Name (Legal Business Name): KAYLA LYNN BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2022
Last Update Date: 06/29/2026
Certification Date: 06/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PSC 455 BOX 208
FPO AP
96540-0003
US

IV. Provider business mailing address

PO BOX 1069
ORIENTAL NC
28571-1069
US

V. Phone/Fax

Practice location:
  • Phone: 671-344-9340
  • Fax:
Mailing address:
  • Phone: 910-382-7814
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number0102208018
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: