Provider Demographics
NPI:1144312448
Name:BAKER, JESSICA LAILE (CRNA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:LAILE
Last Name:BAKER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 COBBLESTONE CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-3739
Mailing Address - Country:US
Mailing Address - Phone:501-626-6260
Mailing Address - Fax:501-753-5011
Practice Address - Street 1:5201 NORTHSHORE DR
Practice Address - Street 2:
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72118-5312
Practice Address - Country:US
Practice Address - Phone:501-748-8000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARCO1411367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5X206OtherBLUE CROSS OF AR
AR154338701Medicaid