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General NPI Number Information
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NPI Number | 1407697857
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Entity Type | Individual
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Provider Name | TIMOTHY BAKER FNP-C
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Gender | Male
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Dates
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Enumeration Date | 05/31/2024
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Last Update Date | 02/14/2025
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Provider Practice Location Address
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Address Line | 4995 US HIGHWAY 68
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City | GOLDEN VALLEY
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State | AZ
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Zip | 86413-5500
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Country | US
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Telephone | 928-681-8500
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Fax | 928-565-4104
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Provider Business Mailing Address
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Address Line | 3369 ROSEWOOD ST
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City | KINGMAN
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State | AZ
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Zip | 86401-2306
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Country | US
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Telephone | 928-419-1140
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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 | RNP308197
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License Number State | AZ
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