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NPI Code Detail

MEDICARE: MR. FRED POWELL BAKER JR. RN-PMHNP-BC

MEDICARE: MR. FRED POWELL BAKER JR. RN-PMHNP-BC
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
1363LP0808XPsychiatric/Mental Health Nurse Practitioner529711TX
2364SP0808XPsychiatric/Mental Health Clinical Nurse SpecialistRN LIC. NO. 529711TX

General Provider Information

NPI Number : 1720040157
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. FRED POWELL BAKER JR. RN-PMHNP-BC
Provider Business Mailing Address
First Line : 7901 METROPOLIS DR
Second Line : VA OUTPATIENT CLINIC
City : AUSTIN
State : TX
Zip : 78744-3111
Country : US
Telephone Number : 512-823-4342
Fax Number :
Provider Business Practice Location Address
First Line : 7901 METROPOLIS DR # 78744
Second Line : VA OUTPATIENT CLINIC
City : AUSTIN
State : TX
Zip : 78744-3111
Country : US
Telephone Number : 512-823-4342
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 04/03/2006
Last Update Date : 07/23/2014

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