Healthcare Provider Details

I. General information

NPI: 1598906794
Provider Name (Legal Business Name): AMY BAGGETT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/18/2009
Last Update Date: 03/18/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

UNIT 15244 BOX 703
APO AP
96205-5244
US

IV. Provider business mailing address

UNIT 15244 BOX 703
APO AP
96205-5244
US

V. Phone/Fax

Practice location:
  • Phone: 01057213711
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License Number68828
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: