Healthcare Provider Details

I. General information

NPI: 1992560387
Provider Name (Legal Business Name): HOLLY C BAKER MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2024
Last Update Date: 02/15/2024
Certification Date: 02/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N MAIN ST
ULYSSES KS
67880-2135
US

IV. Provider business mailing address

PO BOX 505
LAKIN KS
67860-0505
US

V. Phone/Fax

Practice location:
  • Phone: 620-356-1261
  • Fax:
Mailing address:
  • Phone: 620-640-2863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number5382861
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: