IndividualActive
Ian Lloyd Baccay, RN
NPI 1093496069 · Nurse Practitioner · Fort Mohave, AZ
Provider details
- NPI number
- 1093496069
- Entity type
- Individual
- Primary specialty
- Nurse PractitionerPhysician Assistants & Advanced Practice Nursing Providers
- Credential
- RN
- Sex
- Male
- Sole proprietor
- Yes
- License
- 100460 (GU)
Specialties & taxonomies
Physician Assistants & Advanced Practice Nursing Providers
Physician Assistants & Advanced Practice Nursing Providers
Practice location
5263 S Highway 95 , Fort Mohave, Az 86426
Fort Mohave, AZ 86426-9223
Phone: (928) 704-6400
Approximate (ZIP-level) locationGet directions
Mailing address
4425 S Bernard Pl
Fort Mohave, AZ 86426-5388
Registry dates
- Enumerated
- 2023-07-31
- Last updated
- 2025-06-12
- Certified
- 2025-06-12
Source: CMS NPPES Data Dissemination (June 2026). NPI Central is not affiliated with CMS. Data is provided as-is from the public registry.