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General NPI Number Information
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NPI Number | 1326552191
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Entity Type | Individual
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Provider Name | DALTON DEAN BAKER
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Gender | Male
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Dates
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Enumeration Date | 11/30/2017
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Last Update Date | 09/09/2020
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Provider Practice Location Address
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Address Line | 512 N NEW ST
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City | KIRKSVILLE
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State | MO
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Zip | 63501-3167
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Country | US
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Telephone | 660-988-4723
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Fax |
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Provider Business Mailing Address
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Address Line | 512 N NEW ST
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City | KIRKSVILLE
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State | MO
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Zip | 63501-3167
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Country | US
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Telephone |
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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 | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number | 2013022156
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | A149860
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License Number State | IA
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