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General NPI Number Information
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NPI Number | 1740965748
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Entity Type | Individual
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Provider Name | KOURTNEY ANN BAKER PA
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Gender | Female
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Dates
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Enumeration Date | 06/16/2023
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Last Update Date | 06/16/2023
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Provider Practice Location Address
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Address Line | 1107 W POPLAR AVE
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City | PORTERVILLE
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State | CA
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Zip | 93257-5839
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Country | US
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Telephone | 342-687-7960
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Fax |
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Provider Business Mailing Address
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Address Line | 4879 FARNSWORTH RD
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City | MARION
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State | NY
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Zip | 14505-9327
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Country | US
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Telephone | 585-355-6938
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number |
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License Number State |
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