Healthcare Provider Details

I. General information

NPI: 1972414100
Provider Name (Legal Business Name): JADA SHALOME BAKER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/16/2026
Last Update Date: 09/16/2026
Certification Date: 09/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

188 E JEFFERSON ST
PHOENIX AZ
85004-2959
US

IV. Provider business mailing address

188 E JEFFERSON ST APT 1109
PHOENIX AZ
85004-2943
US

V. Phone/Fax

Practice location:
  • Phone: 310-571-5488
  • Fax:
Mailing address:
  • Phone: 336-624-9153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number345511
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: