Healthcare Provider Details

I. General information

NPI: 1063659043
Provider Name (Legal Business Name): JENNIFER BAILEY BAXTER APHN, BSN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/14/2009
Last Update Date: 01/14/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4500 STUART ST MONCRIEF ARMY COMMUNITY HOSPITAL/CREDENTIALS
COLUMBIA SC
29207-5700
US

IV. Provider business mailing address

4500 STUART ST MONCRIEF ARMY COMMUNITY HOSPITAL ATTN: CREDENTIALS
COLUMBIA SC
29207-5700
US

V. Phone/Fax

Practice location:
  • Phone: 803-751-6931
  • Fax:
Mailing address:
  • Phone: 803-751-6931
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC1500X
TaxonomyCommunity Health Registered Nurse
License NumberRN185528
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: