Provider Demographics
NPI:1467876615
Name:BAKER, ALEX WADE (PA-C)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:WADE
Last Name:BAKER
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:710 MARION ST
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-4832
Mailing Address - Country:US
Mailing Address - Phone:501-278-2800
Mailing Address - Fax:501-203-0592
Practice Address - Street 1:710 MARION ST
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4832
Practice Address - Country:US
Practice Address - Phone:501-278-2800
Practice Address - Fax:501-203-0592
Is Sole Proprietor?:No
Enumeration Date:2014-02-08
Last Update Date:2022-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1635225100000X
FLPA9110930363A00000X
ARPA-536363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR201627795Medicaid