Healthcare Provider Details

I. General information

NPI: 1205527405
Provider Name (Legal Business Name): KAMERON R BAKER
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2023
Last Update Date: 05/17/2023
Certification Date: 05/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1822 S 4TH ST
AMES IA
50011-1142
US

IV. Provider business mailing address

2513 BRUNER DR. UNIT 112 APT F
AMES IA
50010
US

V. Phone/Fax

Practice location:
  • Phone: 515-294-6721
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: