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Individual
NICHOLAS JOEL BAKER
Active
Individual
NICHOLAS JOEL BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
01211
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
#001948536
MT. STATE BC/BS SERVICE N
WV
01
—
#145072
CARELINK
WV
01
—
001804181
MT. STATE BC/BS PAY TO #
WV
01
—
001967359
MT. STATE BC/BS PAY TO #
WV
01
—
01211
WV LICENSE
WV
01
—
55-0695143
HEALTH PARTNERS NETWORK
WV
01
—
FQ1211
HEALTH PLAN
WV
01
—
P00670282
RAILROAD MEDICARE PTAN
—
Enumeration date
02/05/2007
Last updated
10/17/2022
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