Provider Demographics
NPI:1093377095
Name:BAKER, SEAN KELLY (CNP)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:KELLY
Last Name:BAKER
Suffix:
Gender:M
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:LINDSAY
Mailing Address - State:OK
Mailing Address - Zip Code:73052-5633
Mailing Address - Country:US
Mailing Address - Phone:405-756-1414
Mailing Address - Fax:
Practice Address - Street 1:216 S MAIN ST
Practice Address - Street 2:
Practice Address - City:LINDSAY
Practice Address - State:OK
Practice Address - Zip Code:73052-5634
Practice Address - Country:US
Practice Address - Phone:405-756-1414
Practice Address - Fax:405-756-1162
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-01
Last Update Date:2019-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK78962207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty