Provider Demographics
NPI:1992771927
Name:BAKER, ASHLEY GLOVER (PA C)
Entity type:Individual
Prefix:MRS
First Name:ASHLEY
Middle Name:GLOVER
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:PO BOX 848491
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75284-8491
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:50 HILLCREST MEDICAL BLVD STE 206
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-8954
Practice Address - Country:US
Practice Address - Phone:254-202-7950
Practice Address - Fax:254-202-7999
Is Sole Proprietor?:No
Enumeration Date:2006-02-28
Last Update Date:2022-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA02012363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86N514OtherBCBS
TX85N072Medicare ID - Type Unspecified
TX86N514OtherBCBS
85N072Medicare PIN