Provider Demographics
NPI:1972549947
Name:BAKER, SHIRLEY JEANNE (PA-C)
Entity type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:JEANNE
Last Name:BAKER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1500 UNIVERSITY DR E
Mailing Address - Street 2:#100
Mailing Address - City:COLLEGE STATION
Mailing Address - State:TX
Mailing Address - Zip Code:77840-2600
Mailing Address - Country:US
Mailing Address - Phone:979-846-1100
Mailing Address - Fax:979-260-9390
Practice Address - Street 1:623 W LASSATER
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:TX
Practice Address - Zip Code:75833-1959
Practice Address - Country:US
Practice Address - Phone:903-289-1070
Practice Address - Fax:936-744-1419
Is Sole Proprietor?:No
Enumeration Date:2006-06-20
Last Update Date:2024-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02294363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1568519122OtherNPI CLINIC
TX183142201Medicaid
TX185649401Medicaid
TX187842301Medicaid
TX000951608Medicaid
TX154467803Medicaid
TX741715140OtherTAX ID
TX154467801Medicaid
TX1821185299OtherNPI AGENCY
TX451986Medicare Oscar/Certification
TX671848Medicare Oscar/Certification
TXQ32895Medicare UPIN
TX451942Medicare Oscar/Certification
TX183142201Medicaid
TX451981Medicare Oscar/Certification
TX1821185299OtherNPI AGENCY
TX741715140OtherTAX ID