Basic Information
| Provider Information | |||||||||
| NPI: | 1639362536 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BAIRD | ||||||||
| FirstName: | ALICIA | ||||||||
| MiddleName: | MARY | ||||||||
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| Credential: | APRN | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1714A BARTON HILLS DR | ||||||||
| Address2: | |||||||||
| City: | AUSTIN | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787042765 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8456497342 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 5524 BEE CAVES RD STE H2 | ||||||||
| Address2: | |||||||||
| City: | WEST LAKE HILLS | ||||||||
| State: | TX | ||||||||
| PostalCode: | 787465246 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5126493050 | ||||||||
| FaxNumber: | 5127176337 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2007 | ||||||||
| LastUpdateDate: | 12/20/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/20/2019 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 078554 | CT | N | Nursing Service Providers | Registered Nurse | 163W00000X | 908240 | TX | N | Nursing Service Providers | Registered Nurse | 163W00000X | 735072 | CA | N | Nursing Service Providers | Registered Nurse | 363L00000X | 18505 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 363LA2200X | 003690 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LP0808X | 003690 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health | 364S00000X | 3052 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | 364SP0809X | 003690 | CT | N | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Psych/Mental Health, Adult | 363LP0808X | AP132102 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
ID Information
| ID | Type | State | Issuer | Description | 004236346 | 05 | CT | MEDICAID |