Healthcare Provider Details

I. General information

NPI: 1649568171
Provider Name (Legal Business Name): KELLI BAKER ANP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2011
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9600 PATTERSON AVE
RICHMOND VA
23229-6015
US

IV. Provider business mailing address

9600 PATTERSON AVE
RICHMOND VA
23229-6015
US

V. Phone/Fax

Practice location:
  • Phone: 804-741-6200
  • Fax:
Mailing address:
  • Phone: 804-741-6200
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024169516
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: