Provider Demographics
NPI:1407697857
Name:BAKER, TIMOTHY (FNP-C)
Entity type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:BAKER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3369 ROSEWOOD ST
Mailing Address - Street 2:
Mailing Address - City:KINGMAN
Mailing Address - State:AZ
Mailing Address - Zip Code:86401-2306
Mailing Address - Country:US
Mailing Address - Phone:928-419-1140
Mailing Address - Fax:
Practice Address - Street 1:4995 US HIGHWAY 68
Practice Address - Street 2:
Practice Address - City:GOLDEN VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:86413-5500
Practice Address - Country:US
Practice Address - Phone:928-681-8500
Practice Address - Fax:928-565-4104
Is Sole Proprietor?:Yes
Enumeration Date:2024-05-31
Last Update Date:2025-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZRNP308197363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily