Healthcare Provider Details

I. General information

NPI: 1568403616
Provider Name (Legal Business Name): DOROTHY R BAKER RN MSN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DOROTHY BRADY

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 09/07/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8726 US HWY 42
FLORENCE KY
41042
US

IV. Provider business mailing address

PO BOX 635283
CINCINNATI OH
45263-5283
US

V. Phone/Fax

Practice location:
  • Phone: 859-384-2660
  • Fax: 859-384-5248
Mailing address:
  • Phone: 859-384-2660
  • Fax: 859-384-5248

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number2539P
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.07753
License Number StateOH
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number221135
License Number StateOH
# 4
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1058398
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: