Healthcare Provider Details

I. General information

NPI: 1942113675
Provider Name (Legal Business Name): MYRA BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: CAYCEE CHAVIS

II. Dates (important events)

Enumeration Date: 09/24/2026
Last Update Date: 09/24/2026
Certification Date: 09/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

105 EAST MAIN ST
ROWLAND NC
28383
US

IV. Provider business mailing address

256 MELBOURNE RD
ROWLAND NC
28383-9634
US

V. Phone/Fax

Practice location:
  • Phone: 910-474-4110
  • Fax:
Mailing address:
  • Phone: 910-474-4110
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHC8479
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: