Provider Demographics
NPI:1740838473
Name:BAKER, JESSICA TYLER (RN)
Entity type:Individual
Prefix:MS
First Name:JESSICA
Middle Name:TYLER
Last Name:BAKER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3849 SADDLEMIRE RD
Mailing Address - Street 2:
Mailing Address - City:BINGHAMTON
Mailing Address - State:NY
Mailing Address - Zip Code:13903-6231
Mailing Address - Country:US
Mailing Address - Phone:607-669-4201
Mailing Address - Fax:607-775-7502
Practice Address - Street 1:3849 SADDLEMIRE RD
Practice Address - Street 2:
Practice Address - City:BINGHAMTON
Practice Address - State:NY
Practice Address - Zip Code:13903-6231
Practice Address - Country:US
Practice Address - Phone:607-669-4201
Practice Address - Fax:607-775-7502
Is Sole Proprietor?:No
Enumeration Date:2019-08-27
Last Update Date:2019-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY646529163WS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WS0200XNursing Service ProvidersRegistered NurseSchool