1972549947 NPI number — SHIRLEY JEANNE BAKER PA-C

Table of content: SHIRLEY JEANNE BAKER PA-C (NPI 1972549947)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1972549947 NPI number — SHIRLEY JEANNE BAKER PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAKER
Provider First Name:
SHIRLEY
Provider Middle Name:
JEANNE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
PA-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1972549947
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/12/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1500 UNIVERSITY DR E
Provider Second Line Business Mailing Address:
#100
Provider Business Mailing Address City Name:
COLLEGE STATION
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77840-2600
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
979-846-1100
Provider Business Mailing Address Fax Number:
979-260-9390

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
623 W LASSATER
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CENTERVILLE
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
75833-1959
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
903-289-1070
Provider Business Practice Location Address Fax Number:
936-744-1419
Provider Enumeration Date:
06/20/2006

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: 363A00000X , with the licence number:  PA02294 , 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)

  • Identifier: 1568519122 . This is a "NPI CLINIC" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 183142201 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 185649401 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 187842301 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000951608 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 154467803 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 741715140 . This is a "TAX ID" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: 154467801 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1821185299 . This is a "NPI AGENCY" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




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