Healthcare Provider Details

I. General information

NPI: 1659217891
Provider Name (Legal Business Name): TARA BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 06/23/2026
Certification Date: 06/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 S PREWITT ST
NEVADA MO
64772-1760
US

IV. Provider business mailing address

4108 AREY RD
BATES CITY MO
64011-8133
US

V. Phone/Fax

Practice location:
  • Phone: 816-417-2832
  • Fax:
Mailing address:
  • Phone: 816-417-2832
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: