Healthcare Provider Details

I. General information

NPI: 1164728366
Provider Name (Legal Business Name): ERIN E. BAXTER PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: ERIN DOANE PA-C

II. Dates (important events)

Enumeration Date: 02/04/2011
Last Update Date: 08/10/2022
Certification Date: 08/10/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 E KENOSHA ST
BROKEN ARROW OK
74012-2098
US

IV. Provider business mailing address

6600 S YALE AVE STE 1200
TULSA OK
74136-3333
US

V. Phone/Fax

Practice location:
  • Phone: 918-449-4150
  • Fax: 918-449-4107
Mailing address:
  • Phone: 918-488-6653
  • Fax: 918-488-6098

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number1983
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: