Provider Demographics
NPI:1639362536
Name:BAIRD, ALICIA MARY (APRN)
Entity Type:Individual
Prefix:
First Name:ALICIA
Middle Name:MARY
Last Name:BAIRD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1714A BARTON HILLS DR
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-2765
Mailing Address - Country:US
Mailing Address - Phone:845-649-7342
Mailing Address - Fax:
Practice Address - Street 1:5524 BEE CAVES RD STE H2
Practice Address - Street 2:
Practice Address - City:WEST LAKE HILLS
Practice Address - State:TX
Practice Address - Zip Code:78746-5246
Practice Address - Country:US
Practice Address - Phone:512-649-3050
Practice Address - Fax:512-717-6337
Is Sole Proprietor?:Yes
Enumeration Date:2007-08-23
Last Update Date:2019-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT078554163W00000X
TX908240163W00000X
CA735072163W00000X
CA18505363L00000X
CT003690363LA2200X, 363LP0808X, 364SP0809X
CA3052364S00000X
TXAP132102363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, Adult
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT004236346Medicaid