Healthcare Provider Details

I. General information

NPI: 1841927423
Provider Name (Legal Business Name): SAVANNAH DENISE BAKER ELKINS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SAVANNAH DENISE BAKER

II. Dates (important events)

Enumeration Date: 08/04/2022
Last Update Date: 07/13/2023
Certification Date: 07/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6844 HARRIS PARKWAY SUITE 300
FORT WORTH TX
76132
US

IV. Provider business mailing address

6844 HARRIS PARKWAY STE 300
FORT WORTH TX
76132
US

V. Phone/Fax

Practice location:
  • Phone: 817-263-0007
  • Fax: 817-263-1118
Mailing address:
  • Phone: 817-263-0007
  • Fax: 817-263-1118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA15614
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: