Healthcare Provider Details

I. General information

NPI: 1538537048
Provider Name (Legal Business Name): LAURA BAXLEY FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2015
Last Update Date: 09/18/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3980 HIGHWAY 9 E STE 320
LITTLE RIVER SC
29566-8165
US

IV. Provider business mailing address

3980 HIGHWAY 9 E STE 320
LITTLE RIVER SC
29566-8165
US

V. Phone/Fax

Practice location:
  • Phone: 843-366-3715
  • Fax:
Mailing address:
  • Phone: 843-366-3715
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number30525
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: