Healthcare Provider Details

I. General information

NPI: 1902237001
Provider Name (Legal Business Name): BETTY BAXTER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/28/2013
Last Update Date: 11/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2122 CIRCLE DR
COLUMBIA TN
38401-4430
US

IV. Provider business mailing address

2122 CIRCLE DR
COLUMBIA TN
38401-4430
US

V. Phone/Fax

Practice location:
  • Phone: 931-490-1480
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code376K00000X
TaxonomyNurse's Aide
License Number00007560
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: