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General NPI Number Information
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NPI Number | 1407351224
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Entity Type | Individual
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Provider Name | KELLY BAXTER MD
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Gender | Female
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Dates
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Enumeration Date | 03/25/2018
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 455 W BROADWAY AVE
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City | JACKSON
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State | WY
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Zip | 83001-8639
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Country | US
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Telephone | 307-733-6111
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Fax | 307-739-6105
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Provider Business Mailing Address
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Address Line | PO BOX 428
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City | JACKSON
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State | WY
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Zip | 83001-0428
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Country | US
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Telephone | 307-739-8999
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Fax | 307-739-4811
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | DR.0062940
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 13126A
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License Number State | WY
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