Provider Demographics
NPI:1770091266
Name:BAKER, JESSIE L (AGACNP)
Entity type:Individual
Prefix:MRS
First Name:JESSIE
Middle Name:L
Last Name:BAKER
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:552 N OLIPHANT ST
Mailing Address - Street 2:
Mailing Address - City:WEST BRANCH
Mailing Address - State:IA
Mailing Address - Zip Code:52358-9701
Mailing Address - Country:US
Mailing Address - Phone:319-325-3514
Mailing Address - Fax:
Practice Address - Street 1:200 HAWKINS DR
Practice Address - Street 2:DEPARTMENT OF CARDIOVASCULAR MEDICINE
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52242-1009
Practice Address - Country:US
Practice Address - Phone:319-356-2750
Practice Address - Fax:319-353-6343
Is Sole Proprietor?:No
Enumeration Date:2018-01-18
Last Update Date:2018-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IAH111156363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner