Provider Demographics
NPI:1053896563
Name:BAKER, SAMANTHA JANE (APRN)
Entity type:Individual
Prefix:
First Name:SAMANTHA
Middle Name:JANE
Last Name:BAKER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:700 W LINCOLN TRAIL BLVD
Mailing Address - Street 2:
Mailing Address - City:RADCLIFF
Mailing Address - State:KY
Mailing Address - Zip Code:40160-2604
Mailing Address - Country:US
Mailing Address - Phone:270-351-3192
Mailing Address - Fax:270-351-5499
Practice Address - Street 1:700 W LINCOLN TRAIL BLVD
Practice Address - Street 2:
Practice Address - City:RADCLIFF
Practice Address - State:KY
Practice Address - Zip Code:40160-2604
Practice Address - Country:US
Practice Address - Phone:270-351-3192
Practice Address - Fax:270-351-5499
Is Sole Proprietor?:No
Enumeration Date:2018-10-01
Last Update Date:2018-10-05
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY1125296363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology