Provider Demographics
NPI:1285705558
Name:BAKER, JACQUELINE RENEE (PA-C)
Entity type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:RENEE
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1760 NICHOLASVILLE RD
Mailing Address - Street 2:SUITE 502
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1471
Mailing Address - Country:US
Mailing Address - Phone:859-278-2232
Mailing Address - Fax:859-278-1543
Practice Address - Street 1:1760 NICHOLASVILLE RD
Practice Address - Street 2:SUITE 502
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1471
Practice Address - Country:US
Practice Address - Phone:859-278-2232
Practice Address - Fax:859-278-1543
Is Sole Proprietor?:No
Enumeration Date:2006-11-10
Last Update Date:2020-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA971363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100012460Medicaid