Healthcare Provider Details

I. General information

NPI: 1568691566
Provider Name (Legal Business Name): DIANA C. BAKER ED.D., FNP, CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/11/2009
Last Update Date: 03/25/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5179 NORMANDY LN
MEMPHIS TN
38117-2850
US

IV. Provider business mailing address

5179 NORMANDY LN
MEMPHIS TN
38117-2850
US

V. Phone/Fax

Practice location:
  • Phone: 901-682-4028
  • Fax: 901-682-4028
Mailing address:
  • Phone: 901-682-4028
  • Fax: 901-682-4028

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SP0809X
TaxonomyAdult Psychiatric/Mental Health Clinical Nurse Specialist
License NumberAPN0000005042
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: