Healthcare Provider Details

I. General information

NPI: 1346661402
Provider Name (Legal Business Name): CAGNEY BAKER RN-BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/17/2013
Last Update Date: 12/19/2022
Certification Date: 12/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

338 E COLUMBIA AVE
BATESBURG LEESVILLE SC
29070-9285
US

IV. Provider business mailing address

470 HULON LANE ATTN: VP OF REVENUE CYCLE
WEST COLUMBIA SC
29169-4810
US

V. Phone/Fax

Practice location:
  • Phone: 803-604-0066
  • Fax: 803-604-9924
Mailing address:
  • Phone: 803-791-2000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WS0200X
TaxonomySchool Registered Nurse
License Number205622
License Number StateSC
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number24193
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: