Individual
KELLIE ELIZABETH BAKER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
RN
Contact information
Practice address
1475 E LIBERTY ST, YORK, SC 29745-6440
(803) 684-1905
(803) 684-1907
Mailing address
18 SPRUCE ST, YORK, SC 29745-1734
(803) 684-1905
(803) 684-1907
Taxonomy
Speciality
Code
Description
License number
State
163WS0200X
School Registered Nurse
Primary
109368
SC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1003845777
—
SC
Enumeration date
08/13/2019
Last updated
08/13/2019
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