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General NPI Number Information
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NPI Number | 1053085696
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Entity Type | Individual
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Provider Name | KRISTEN M BAKER NURSE PRACTITIONER
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Gender | Female
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Dates
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Enumeration Date | 08/06/2021
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Last Update Date | 08/06/2021
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Provider Practice Location Address
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Address Line | 99 E STATE ST STE 106
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City | GLOVERSVILLE
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State | NY
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Zip | 12078-1293
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Country | US
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Telephone | 518-773-5393
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Fax |
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Provider Business Mailing Address
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Address Line | 4926 STATE HIGHWAY 29
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City | JOHNSTOWN
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State | NY
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Zip | 12095-4702
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Country | US
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Telephone | 518-428-0441
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 348004
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License Number State | NY
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