MEDICARE: KRISTIN NICOLE BAXTER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavior Analyst
2	106S00000X	Behavior Technician

General Provider Information

NPI Number	:	1568968964
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KRISTIN NICOLE BAXTER

Provider Business Mailing Address
First Line	:	818 N RIVER AVE
Second Line	:
City	:	ALMA
State	:	MI
Zip	:	48801-1251
Country	:	US
Telephone Number	:	989-763-8041
Fax Number	:

Provider Business Practice Location Address
First Line	:	11807 ALLISONVILLE RD # 522
Second Line	:
City	:	FISHERS
State	:	IN
Zip	:	46038-2313
Country	:	US
Telephone Number	:	989-839-2290
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/04/2018
Last Update Date	:	05/21/2025

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