Healthcare Provider Details

I. General information

NPI: 1245567965
Provider Name (Legal Business Name): CLIFTON RICHARD BAKER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/17/2009
Last Update Date: 10/02/2025
Certification Date: 10/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11600 BUSY ST STE 203
NORTH CHESTERFIELD VA
23236-4066
US

IV. Provider business mailing address

2304 LEIGHTON CT
RICHMOND VA
23238-3020
US

V. Phone/Fax

Practice location:
  • Phone: 804-506-0526
  • Fax: 804-506-0526
Mailing address:
  • Phone: 804-938-0683
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number0024180217
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number0024180217
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001203890
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: