Healthcare Provider Details

I. General information

NPI: 1255006367
Provider Name (Legal Business Name): KAYLA BAKER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2021
Last Update Date: 04/01/2024
Certification Date: 04/01/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1200 BRIDGES AVE E
WYNNE AR
72396-2449
US

IV. Provider business mailing address

2707 BROWNS LN
JONESBORO AR
72401-7213
US

V. Phone/Fax

Practice location:
  • Phone: 870-336-1300
  • Fax:
Mailing address:
  • Phone: 870-972-4050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA2107014
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberP2403021
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: