Provider Demographics
NPI:1871265645
Name:BAKER, TESHA LANATTE (LPN)
Entity Type:Individual
Prefix:MS
First Name:TESHA
Middle Name:LANATTE
Last Name:BAKER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 S 2ND ST
Mailing Address - Street 2:
Mailing Address - City:DES ARC
Mailing Address - State:AR
Mailing Address - Zip Code:72040-3034
Mailing Address - Country:US
Mailing Address - Phone:870-256-5669
Mailing Address - Fax:
Practice Address - Street 1:610 S 2ND ST
Practice Address - Street 2:
Practice Address - City:DES ARC
Practice Address - State:AR
Practice Address - Zip Code:72040-3034
Practice Address - Country:US
Practice Address - Phone:870-256-5669
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-30
Last Update Date:2021-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARL056480164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ARL056480OtherSTATE BOARD OF NURSING