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General NPI Number Information
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NPI Number | 1558969469
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Entity Type | Individual
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Provider Name | KENNETH STARLING BAKER III AGPCNP-BC
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Gender | Male
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Dates
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Enumeration Date | 10/13/2020
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Last Update Date | 12/09/2020
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Provider Practice Location Address
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Address Line | 740 S LIMESTONE STE B101
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City | LEXINGTON
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State | KY
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Zip | 40536-0284
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Country | US
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Telephone | 859-323-5661
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Fax |
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Provider Business Mailing Address
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Address Line | 493 AMBERLEY DR
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City | LEXINGTON
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State | KY
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Zip | 40515-4775
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Country | US
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Telephone | 606-854-6120
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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 | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1137306
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363LG0600X
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Taxonomy Name | Gerontology Nurse Practitioner
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License Number | 1137306
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License Number State | KY
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 2020044609
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License Number State | KY
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