Healthcare Provider Details

I. General information

NPI: 1174956460
Provider Name (Legal Business Name): JODIE LYN BAKER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 07/27/2022
Certification Date: 07/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

575 HILL COUNTRY DR STE 202
KERRVILLE TX
78028-6024
US

IV. Provider business mailing address

575 HILL COUNTRY DR
KERRVILLE TX
78028-6024
US

V. Phone/Fax

Practice location:
  • Phone: 830-258-6237
  • Fax: 830-895-7757
Mailing address:
  • Phone: 830-258-7762
  • Fax: 830-258-7098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number670987
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License NumberAP124154
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: