Provider Demographics
NPI:1588724223
Name:BAKER, KAREN (FNPC)
Entity type:Individual
Prefix:MRS
First Name:KAREN
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:FNPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3048
Mailing Address - Street 2:1710 SOUTH SLAPPEY BLVD
Mailing Address - City:ALBANY
Mailing Address - State:GA
Mailing Address - Zip Code:31706-3048
Mailing Address - Country:US
Mailing Address - Phone:229-430-0463
Mailing Address - Fax:229-430-0473
Practice Address - Street 1:213 OLD RADIUM SPRINGS ROAD
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:GA
Practice Address - Zip Code:31705
Practice Address - Country:US
Practice Address - Phone:229-430-0463
Practice Address - Fax:229-430-0473
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN080779363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00886685AMedicaid