Healthcare Provider Details

I. General information

NPI: 1003467937
Provider Name (Legal Business Name): CHEYANNA HOPE BAKER CADC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/23/2019
Last Update Date: 07/30/2021
Certification Date: 07/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

149 DEWEESE ST
LEXINGTON KY
40507-1925
US

IV. Provider business mailing address

114 ROBBIE DR
LAWRENCEBURG KY
40342-1495
US

V. Phone/Fax

Practice location:
  • Phone: 859-229-6235
  • Fax:
Mailing address:
  • Phone: 859-229-6235
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number271009
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: