Healthcare Provider Details

I. General information

NPI: 1780796631
Provider Name (Legal Business Name): CYNTHIA NICOLLE BAXLEY WHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 10/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9330 PARKWEST BLVD STE 302
KNOXVILLE TN
37923-4311
US

IV. Provider business mailing address

10943 TOPVIEW LANE
KNOXVILLE TN
37934
US

V. Phone/Fax

Practice location:
  • Phone: 865-531-5878
  • Fax: 865-531-7690
Mailing address:
  • Phone: 865-621-5977
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LW0102X
TaxonomyWomen's Health Nurse Practitioner
License NumberAPN0000008309
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: