Samantha Jane Baker, APRN
Individual provider Active NPI Gerontology Nurse Practitioner · Radcliff, KY
NPI 1053896563 · NPPES record last updated Oct 5, 2018
Key facts
- NPI
- 1053896563
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Gerontology Nurse Practitioner 363LG0600X
- License
- 1125296 (KY)
- Practice address
- 700 W Lincoln Trail Blvd
Radcliff, KY 40160-2604 - Phone
- (270) 351-3192
- Fax
- (270) 351-5499
- NPI assigned
- Oct 1, 2018
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in KY
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20181129003386 | KY | Practitioner - Nurse Practitioner | 4688918774 | Reassigns benefits to 2 organizations |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 1125296 | KY | MD | Gerontology Nurse Practitioner |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Central Medical Associates PLLC | Current |
Accepting new patients | |
| Signify Health, LLC | Current |
Accepting new patients |
Locations
1321 Ring Rd
Ste 105
Elizabethtown, KY 42701
Phone (270) 986-7372
312 S 4th St
Ste 700
Louisville, KY 40202
Phone (502) 628-5023
700 W Lincoln Trail Blvd
Radcliff, KY 40160
Phone (270) 351-3192
4055 Valley View Ln
Ste 400
Dallas, TX 75244
Phone (469) 466-7037
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Gerontology Nurse Practitioner | 363LG0600X | 1125296 | KY | Yes |
Addresses
Primary practice location
700 W Lincoln Trail Blvd
Radcliff, KY 40160-2604
Mailing address
700 W Lincoln Trail Blvd
Radcliff, KY 40160-2604
Phone (270) 351-3192
Other providers in Radcliff, KY
- Norman Wayne Ayotte Jr.
- Keith Alan Bailey
- Nicole Bailey
- Tywahneikai Lashae Bailey
- Karen M Baker
- Jessica Lynn Ballard
- Baptist Health Medical Group Inc
- Baptist Health Medical Group Inc
- Baptist Healthcare System Inc
- Misty D Barbieri
All providers in Radcliff, KY · Gerontology Nurse Practitioner in Kentucky
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 5, 2018. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.