1215186531 NPI number — DR. KRYSTIN CALHOUN BAKER M.D.

Table of content: DR. KRYSTIN CALHOUN BAKER M.D. (NPI 1215186531)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215186531 NPI number — DR. KRYSTIN CALHOUN BAKER M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
KRYSTIN
Provider Middle Name:
CALHOUN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALHOUN
Provider Other First Name:
KRYSTIN
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.D.
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1215186531
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/26/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1100 N 19TH ST
Provider Second Line Business Mailing Address:
SUITE 200
Provider Business Mailing Address City Name:
ABILENE
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
79601-2344
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
325-670-6190
Provider Business Mailing Address Fax Number:
325-670-6191

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1100 N 19TH ST
Provider Second Line Business Practice Location Address:
SUITE 200
Provider Business Practice Location Address City Name:
ABILENE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
79601-2344
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
325-670-6190
Provider Business Practice Location Address Fax Number:
325-670-6191
Provider Enumeration Date:
09/10/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2084N0400X , with the licence number:  N0623 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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