Basic Information
| Provider Information | |||||||||
| NPI: | 1467876615 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAKER | ||||||||
| FirstName: | ALEX | ||||||||
| MiddleName: | WADE | ||||||||
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| Credential: | PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 710 MARION ST | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721434832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012782800 | ||||||||
| FaxNumber: | 5012030592 | ||||||||
| Practice Location | |||||||||
| Address1: | 710 MARION ST | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721434832 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012782800 | ||||||||
| FaxNumber: | 5012030592 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/08/2014 | ||||||||
| LastUpdateDate: | 09/16/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 09/16/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 1635 | AR | N | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 363A00000X | PA9110930 | FL | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA-536 | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | 201627795 | 05 | AR | MEDICAID |