Healthcare Provider Details

I. General information

NPI: 1851856512
Provider Name (Legal Business Name): BRITTANY MARIE BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/07/2019
Last Update Date: 02/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

140 DAMERON AVE # 1800
KNOXVILLE TN
37917-6434
US

IV. Provider business mailing address

140 DAMERON AVE # 1800
KNOXVILLE TN
37917-6434
US

V. Phone/Fax

Practice location:
  • Phone: 865-215-5354
  • Fax:
Mailing address:
  • Phone: 865-215-5354
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code246Z00000X
TaxonomyOther Specialist/Technologist
License Number2488246
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: