Healthcare Provider Details

I. General information

NPI: 1861443384
Provider Name (Legal Business Name): MELISSA J BAKER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/12/2006
Last Update Date: 12/08/2025
Certification Date: 12/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

720 W MAIN ST
CLARKSON KY
42726-7048
US

IV. Provider business mailing address

5966 SCOTTSVILLE RD STE 3
BOWLING GREEN KY
42104-7908
US

V. Phone/Fax

Practice location:
  • Phone: 270-904-5104
  • Fax: 270-201-5980
Mailing address:
  • Phone: 270-904-5104
  • Fax: 270-201-5980

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3004685
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: