Ellie Anne Baker, PA-C

Key facts

NPI

1962266619

Entity type

Individual (NPI type 1)

Primary specialty

Ophthalmic Plastic and Reconstructive Surgery Physician 207WX0200X

License

PT2024-014 (AR)

Practice address

158 E Sunbridge Dr
Fayetteville, AR 72703-2830

Phone

(479) 222-0983

Fax

(361) 585-4765

NPI assigned

Feb 12, 2024

Sex

Female

Sole proprietor

No

Medicare participation

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No

National Provider Directory

Medicare enrollment (NPD)

Yes

State licenses

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 10, 2024.

{
    "created_epoch": "1707696000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1717977600000",
    "number": "1962266619",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "158 E SUNBRIDGE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727032830",
            "telephone_number": "479-222-0983",
            "fax_number": "361-585-4765"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "158 E SUNBRIDGE DR",
            "city": "FAYETTEVILLE",
            "state": "AR",
            "postal_code": "727032830",
            "telephone_number": "479-222-0983",
            "fax_number": "361-585-4765"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BAKER",
        "first_name": "ELLIE",
        "middle_name": "ANNE",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-02-12",
        "last_updated": "2024-06-10",
        "certification_date": "2024-06-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207WX0200X",
            "taxonomy_group": "",
            "desc": "Ophthalmology, Ophthalmic Plastic and Reconstructive Surgery",
            "state": "AR",
            "license": "PT2024-014",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fayetteville, AR

• Bonnie Jean Lynch Baker, M.D.
• Brenda Lou Baker, L.C.S.W.,L.A.D.A.C.
• Cheyenne Baker
• Crystal Raye Baker, LPC
• Don Baker, RPH
• Ethan Baker
• Jennie Elizabeth Baker, APN
• Jessica Baker, PT
• Kimberly Frazier Baker, PH.D.
• Peyton D Baker, DPM

All providers in Fayetteville, AR · Ophthalmic Plastic and Reconstructive Surgery Physician in Arkansas