Healthcare Provider Details

I. General information

NPI: 1972980894
Provider Name (Legal Business Name): HOLLY BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/29/2015
Last Update Date: 03/19/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19006 BLUE VANGA LN
CYPRESS TX
77429-6568
US

IV. Provider business mailing address

19006 BLUE VANGA LN
CYPRESS TX
77429-6568
US

V. Phone/Fax

Practice location:
  • Phone: 713-819-7225
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AS0400X
TaxonomySurgical Physician Assistant
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code246ZC0007X
TaxonomySurgical Assistant
License Number19301899
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: