Healthcare Provider Details

I. General information

NPI: 1780649087
Provider Name (Legal Business Name): RACHEL SUE BAISDEN APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/19/2006
Last Update Date: 06/17/2024
Certification Date: 06/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

184 E 2ND AVE
WILLIAMSON WV
25661-3602
US

IV. Provider business mailing address

PO BOX 2080
WILLIAMSON WV
25661-2080
US

V. Phone/Fax

Practice location:
  • Phone: 304-236-5902
  • Fax: 304-235-8559
Mailing address:
  • Phone: 304-236-5902
  • Fax: 304-235-8559

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number49124
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: