Provider Demographics
NPI:1124889217
Name:BAKER, MARY WILLOW (DNP)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:WILLOW
Last Name:BAKER
Suffix:
Gender:F
Credentials:DNP
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:WILLOW
Other - Last Name:SEABERRY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13418 PECAN STABLE
Mailing Address - Street 2:
Mailing Address - City:HELOTES
Mailing Address - State:TX
Mailing Address - Zip Code:78023-4216
Mailing Address - Country:US
Mailing Address - Phone:719-659-5756
Mailing Address - Fax:
Practice Address - Street 1:13418 PECAN STABLE
Practice Address - Street 2:
Practice Address - City:HELOTES
Practice Address - State:TX
Practice Address - Zip Code:78023-4216
Practice Address - Country:US
Practice Address - Phone:719-659-5756
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-17
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1149094363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner