Provider Demographics
NPI:1427061100
Name:BAKER, KRISTEN A (PA C)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:A
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA C
Other - Prefix:MRS
Other - First Name:KRISTEN
Other - Middle Name:A
Other - Last Name:LANG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:61 EAST AVE
Mailing Address - Street 2:
Mailing Address - City:NORWALK
Mailing Address - State:CT
Mailing Address - Zip Code:06851
Mailing Address - Country:US
Mailing Address - Phone:203-838-8414
Mailing Address - Fax:203-857-5649
Practice Address - Street 1:761 MAIN AVE
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851
Practice Address - Country:US
Practice Address - Phone:203-229-2000
Practice Address - Fax:203-840-9001
Is Sole Proprietor?:No
Enumeration Date:2006-08-14
Last Update Date:2009-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000520208000000X, 363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No208000000XAllopathic & Osteopathic PhysiciansPediatrics