Healthcare Provider Details

I. General information

NPI: 1124764402
Provider Name (Legal Business Name): MEGHAN J BAKER PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2022
Last Update Date: 12/11/2022
Certification Date: 12/11/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2527 E ALTA VISTA RD
PHOENIX AZ
85042-4692
US

IV. Provider business mailing address

2527 E ALTA VISTA RD
PHOENIX AZ
85042-4692
US

V. Phone/Fax

Practice location:
  • Phone: 605-261-9895
  • Fax:
Mailing address:
  • Phone: 605-261-9895
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number093870
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number283698
License Number StateAZ
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN176037
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: