Healthcare Provider Details

I. General information

NPI: 1467911750
Provider Name (Legal Business Name): KAITLEN BAKER MD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KAITLEN COOLEY

II. Dates (important events)

Enumeration Date: 03/15/2019
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1316 S MAIN ST
CLARION IA
50525-2019
US

IV. Provider business mailing address

1316 S MAIN ST
CLARION IA
50525-2019
US

V. Phone/Fax

Practice location:
  • Phone: 844-474-4321
  • Fax: 515-532-9250
Mailing address:
  • Phone: 844-447-4321
  • Fax: 515-532-9250

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number2022035445
License Number StateMO
# 3
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-53871
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: