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General NPI Number Information
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NPI Number | 1841015393
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Entity Type | Individual
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Provider Name | WYLIN BAKER PA-C
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Gender | Male
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Dates
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Enumeration Date | 11/20/2024
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Last Update Date | 11/20/2024
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Provider Practice Location Address
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Address Line | 102 MAJOR ALLEN ST
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City | MARTIN
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State | SD
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Zip | 57551-6005
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Country | US
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Telephone | 605-685-6622
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 70
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City | MARTIN
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State | SD
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Zip | 57551-0070
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Country | US
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Telephone | 605-280-8337
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1573
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License Number State | SD
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