Healthcare Provider Details

I. General information

NPI: 1033717228
Provider Name (Legal Business Name): BAXTER PALLIATIVE CONSULTING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2020
Last Update Date: 10/26/2020
Certification Date: 10/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

55 CHERRY LN
WAKEFIELD RI
02879-3617
US

IV. Provider business mailing address

55 CHERRY LN
WAKEFIELD RI
02879-3617
US

V. Phone/Fax

Practice location:
  • Phone: 401-400-5535
  • Fax:
Mailing address:
  • Phone: 401-400-5535
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LG0600X
TaxonomyGerontology Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. KELLY ESTHER BAXTER
Title or Position: OWNER
Credential: DNP, APRN, ACHPN
Phone: 401-400-5535