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NPI Code Detail

MEDICARE: LYNETTE N BAKER NP

MEDICARE: LYNETTE N BAKER NP
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse Practitioner11607TN
2363LF0000XFamily Nurse Practitioner559025TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1700993011
Entity Type Code : Individual
Provider Name (Legal Business Name) : LYNETTE N BAKER NP
Provider Business Mailing Address
First Line : 6100 JACKSBORO HWY
Second Line :
City : FORT WORTH
State : TX
Zip : 76135-3703
Country : US
Telephone Number : 817-237-4594
Fax Number : 817-237-3008
Provider Business Practice Location Address
First Line : 6100 JACKSBORO HWY
Second Line :
City : FORT WORTH
State : TX
Zip : 76135-3703
Country : US
Telephone Number : 817-237-4594
Fax Number : 817-237-3008
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/23/2006
Last Update Date : 11/17/2009

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Directions to “ LYNETTE N BAKER NP” Practice Location

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