Basic Information
Provider Information
NPI: 1982011086
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: BAIRD
FirstName: ALLISON
MiddleName: KERRY
NamePrefix:  
NameSuffix:  
Credential: NP, RN
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 78 ATLANTIC PL
Address2:  
City: SOUTH PORTLAND
State: ME
PostalCode: 041062316
CountryCode: US
TelephoneNumber: 2076616654
FaxNumber: 2078427773
Practice Location
Address1: 2 SPRINGBROOK DR
Address2:  
City: BIDDEFORD
State: ME
PostalCode: 040059443
CountryCode: US
TelephoneNumber: 2072821500
FaxNumber: 2072822581
Other Information
ProviderEnumerationDate: 07/21/2014
LastUpdateDate: 04/08/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
163W00000XRN62408MEN Nursing Service ProvidersRegistered Nurse 
363LP0808XCNP141023MEY Physician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsych/Mental Health

No ID Information.


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