Healthcare Provider Details

I. General information

NPI: 1982524187
Provider Name (Legal Business Name): KELLYE BAKER DNP, PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/17/2026
Last Update Date: 07/17/2026
Certification Date: 07/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 COX RD STE 205
GLEN ALLEN VA
23060-6803
US

IV. Provider business mailing address

1738 N 28TH ST
RICHMOND VA
23223-5372
US

V. Phone/Fax

Practice location:
  • Phone: 804-338-2582
  • Fax:
Mailing address:
  • Phone: 804-338-2582
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number0024197897
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: