Healthcare Provider Details

I. General information

NPI: 1811313554
Provider Name (Legal Business Name): TAMEISHA G BAXTER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2014
Last Update Date: 11/22/2023
Certification Date: 11/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

133 HARMONY PARK CIR
HOT SPRINGS AR
71913-5417
US

IV. Provider business mailing address

PO BOX 749495
ATLANTA GA
30374-9495
US

V. Phone/Fax

Practice location:
  • Phone: 501-624-7700
  • Fax: 501-623-5788
Mailing address:
  • Phone: 239-432-8331
  • Fax: 813-321-1296

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA004050
License Number StateAR
# 2
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberA004050
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: