Healthcare Provider Details

I. General information

NPI: 1639610587
Provider Name (Legal Business Name): MICHELLE D. BALDWIN DNP, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/12/2017
Last Update Date: 03/12/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 STONEBRIDGE BLVD SUITE C
JACKSON TN
38305-2021
US

IV. Provider business mailing address

7 STONEBRIDGE BLVD SUITE C
JACKSON TN
38305-2021
US

V. Phone/Fax

Practice location:
  • Phone: 731-300-3099
  • Fax:
Mailing address:
  • Phone: 731-300-3099
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPN0000020271
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: