Healthcare Provider Details

I. General information

NPI: 1467489021
Provider Name (Legal Business Name): LINDA COCKRAM BAXTER RN PHD PMHNPCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2006
Last Update Date: 12/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9097 ATLEE STATION RD SUITE 219
MECHANICSVILLE VA
23116-2525
US

IV. Provider business mailing address

8518 CHESTER FOREST LN
NORTH CHESTERFIELD VA
23237-2662
US

V. Phone/Fax

Practice location:
  • Phone: 804-730-2829
  • Fax:
Mailing address:
  • Phone: 804-221-5112
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number0024078127
License Number StateVA
# 2
Primary TaxonomyY
Taxonomy Code163WP0809X
TaxonomyAdult Psychiatric/Mental Health Registered Nurse
License Number0024078127
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: