Individual
KELLY L BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MD
Contact information
Practice address
1819 W CLINCH AVE, SUITE 114, KNOXVILLE, TN 37916-2434
(865) 524-1631
Mailing address
1225 E WEISGARBER RD, SUITE 200, KNOXVILLE, TN 37909-2604
(865) 584-4747
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
34175
TN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
080157086
RR MEDICARE
TN
05
—
3851045
—
TN
Enumeration date
06/15/2006
Last updated
05/11/2011
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