Healthcare Provider Details

I. General information

NPI: 1972961266
Provider Name (Legal Business Name): SOPHIE BAXTER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2016
Last Update Date: 12/03/2025
Certification Date: 12/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

820 E 17TH ST
CHEYENNE WY
82001-4714
US

IV. Provider business mailing address

820 E 17TH ST
CHEYENNE WY
82001-4714
US

V. Phone/Fax

Practice location:
  • Phone: 307-632-2434
  • Fax:
Mailing address:
  • Phone: 307-632-2434
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA1187
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: