Provider Demographics
NPI:1891530481
Name:BAKER, KELLY (DNP, FNP-BC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:BAKER
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12874 PATTERSON AVE STE A
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23238-7101
Mailing Address - Country:US
Mailing Address - Phone:804-330-0303
Mailing Address - Fax:804-327-1677
Practice Address - Street 1:12874 PATTERSON AVE # A
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23238-7101
Practice Address - Country:US
Practice Address - Phone:804-330-0303
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-06-26
Last Update Date:2024-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190505364SF0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes364SF0001XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistFamily HealthGroup - Single Specialty