Provider Demographics
NPI:1316971831
Name:BAKER, KATHERINE A (RPA-C)
Entity type:Individual
Prefix:MS
First Name:KATHERINE
Middle Name:A
Last Name:BAKER
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:MRS
Other - First Name:KATHERINE
Other - Middle Name:
Other - Last Name:MORRIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:49 LAWRENCE AVE
Mailing Address - Street 2:
Mailing Address - City:POTSDAM
Mailing Address - State:NY
Mailing Address - Zip Code:13676-1889
Mailing Address - Country:US
Mailing Address - Phone:315-261-5525
Mailing Address - Fax:315-261-5549
Practice Address - Street 1:50 LEROY ST
Practice Address - Street 2:
Practice Address - City:POTSDAM
Practice Address - State:NY
Practice Address - Zip Code:13676-1786
Practice Address - Country:US
Practice Address - Phone:315-261-5525
Practice Address - Fax:315-261-5549
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2015-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY010135363A00000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYJ400079563OtherPTAN
NYJ400079563OtherPTAN
NYQ36499Medicare UPIN