Healthcare Provider Details

I. General information

NPI: 1780671651
Provider Name (Legal Business Name): CHRISTY QUIRE BAKER FNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CHRISTY QUIRE

II. Dates (important events)

Enumeration Date: 10/05/2005
Last Update Date: 02/21/2020
Certification Date: 02/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1169 EASTERN PKWY STE 431
LOUISVILLE KY
40217-1435
US

IV. Provider business mailing address

1169 EASTERN PKWY STE 431
LOUISVILLE KY
40217-1435
US

V. Phone/Fax

Practice location:
  • Phone: 502-361-3909
  • Fax: 502-361-9229
Mailing address:
  • Phone: 502-953-4783
  • Fax: 502-361-9229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3003085
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3085P
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: