Healthcare Provider Details

I. General information

NPI: 1821480047
Provider Name (Legal Business Name): RYAN BAKER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/25/2015
Last Update Date: 03/20/2020
Certification Date: 03/20/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6 RICHLAND MEDICAL PARK DR STE 2100
COLUMBIA SC
29203
US

IV. Provider business mailing address

112 SALUDA RIDGE CT STE 200
WEST COLUMBIA SC
29169-3461
US

V. Phone/Fax

Practice location:
  • Phone: 803-434-2762
  • Fax:
Mailing address:
  • Phone: 803-296-7320
  • Fax: 803-296-7330

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number19325
License Number StateSC
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number19325
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: