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General NPI Number Information
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NPI Number | 1396095741
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Entity Type | Organization
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Legal Business Name | AMANDA BAKER, P.A.
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Dates
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Enumeration Date | 09/13/2012
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Last Update Date | 09/13/2012
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Provider Practice Location Address
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Address Line | 408 S MAIN ST
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City | JONESBORO
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State | AR
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Zip | 72401-2963
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Country | US
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Telephone | 870-336-7526
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Fax |
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Provider Business Mailing Address
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Address Line | 408 S MAIN ST
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City | JONESBORO
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State | AR
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Zip | 72401-2963
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Country | US
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Telephone | 870-336-7526
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | AMANDA BAKER
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Credential |
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Telephone | 870-336-7526
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number | P1112094
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License Number State | AR
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