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NPI Code Detail

MEDICARE: MRS. KIMBERLY LYNN BAKER AT

MEDICARE:  MRS. KIMBERLY LYNN BAKER  AT
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
12255A2300XAthletic TrainerA0000005MD

General Provider Information

NPI Number : 1740252485
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KIMBERLY LYNN BAKER AT
Provider Business Mailing Address
First Line : 3705 VILLAGE TRL
Second Line :
City : SNOW HILL
State : MD
Zip : 21863-3062
Country : US
Telephone Number : 443-614-4183
Fax Number :
Provider Business Practice Location Address
First Line : 1817 OLD VIRGINIA RD
Second Line :
City : POCOMOKE CITY
State : MD
Zip : 21851-3049
Country : US
Telephone Number : 443-614-4183
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2006
Last Update Date : 11/13/2014

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Directions to “ MRS. KIMBERLY LYNN BAKER AT” Practice Location

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