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General NPI Number Information
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NPI Number | 1376260638
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Entity Type | Individual
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Provider Name | JAMIE LOU BAXTER
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Gender | Female
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Dates
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Enumeration Date | 10/26/2022
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Last Update Date | 10/26/2022
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Provider Practice Location Address
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Address Line | 5108 N MAIDSTONE WAY
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City | BOISE
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State | ID
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Zip | 83713-1367
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Country | US
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Telephone | 208-577-8672
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Fax | 208-209-6058
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Provider Business Mailing Address
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Address Line | 10503 W K BAR T DR
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City | BOISE
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State | ID
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Zip | 83709-2449
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Country | US
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Telephone | 503-407-2693
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 54678
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License Number State | ID
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