Healthcare Provider Details

I. General information

NPI: 1922299395
Provider Name (Legal Business Name): JERI LYNN BAKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2007
Last Update Date: 06/17/2022
Certification Date: 05/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

142 W 5TH ST
COOKEVILLE TN
38501-1760
US

IV. Provider business mailing address

228 W 4TH ST STE 200
COOKEVILLE TN
38501-2489
US

V. Phone/Fax

Practice location:
  • Phone: 931-528-2541
  • Fax:
Mailing address:
  • Phone: 931-372-0405
  • Fax: 931-372-0463

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number7787
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: