Healthcare Provider Details

I. General information

NPI: 1760119341
Provider Name (Legal Business Name): RHONDA CAROL BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 08/04/2022
Certification Date: 08/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

989 HIGHWAY 32 E
HOULKA MS
38850-8206
US

IV. Provider business mailing address

989 HIGHWAY 32 E
HOULKA MS
38850-8206
US

V. Phone/Fax

Practice location:
  • Phone: 662-760-1697
  • Fax:
Mailing address:
  • Phone: 662-760-1697
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number905337
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: