Healthcare Provider Details

I. General information

NPI: 1205558541
Provider Name (Legal Business Name): CASEY BAXTER-WILMS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2022
Last Update Date: 06/18/2025
Certification Date: 06/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 E 11TH ST
CHATTANOOGA TN
37403-3101
US

IV. Provider business mailing address

1908 OAK ST
CHATTANOOGA TN
37404-2632
US

V. Phone/Fax

Practice location:
  • Phone: 423-481-9760
  • Fax: 423-770-9081
Mailing address:
  • Phone: 513-255-5959
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP2300X
TaxonomyPrimary Care Nurse Practitioner
License Number32592
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License Number32592
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: