Healthcare Provider Details

I. General information

NPI: 1679021612
Provider Name (Legal Business Name): LEAH BAKER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: LEAH MAY PA-C

II. Dates (important events)

Enumeration Date: 09/20/2016
Last Update Date: 01/19/2023
Certification Date: 01/19/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

601 CHILDRENS LN
NORFOLK VA
23507-1910
US

IV. Provider business mailing address

P.O. BOX 87
SAN ANTONIO TX
78291
US

V. Phone/Fax

Practice location:
  • Phone: 757-668-7448
  • Fax: 210-567-5169
Mailing address:
  • Phone: 210-358-9172
  • Fax: 210-358-9183

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA10726
License Number StateTX
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number0110007526
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: