Healthcare Provider Details

I. General information

NPI: 1043201445
Provider Name (Legal Business Name): KATHY DAVIS BAKER BSN/CPNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2005
Last Update Date: 06/24/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

615 7TH AVE
BOWLING GREEN KY
42101-6921
US

IV. Provider business mailing address

PO BOX 1177
BOWLING GREEN KY
42102-1177
US

V. Phone/Fax

Practice location:
  • Phone: 270-783-3573
  • Fax:
Mailing address:
  • Phone: 270-783-3573
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number3000397
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: