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NPI Code Detail

MEDICARE: DEBRA B BAXTER FNP-BC

MEDICARE: DEBRA B BAXTER FNP-BC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1363L00000XNurse PractitionerA004596AR
2363L00000XNurse PractitionerR852798MS

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1811079544
Entity Type Code : Individual
Provider Name (Legal Business Name) : DEBRA B BAXTER FNP-BC
Provider Business Mailing Address
First Line : 2918 LOUIS SESSIONS ST
Second Line :
City : LAKE VILLAGE
State : AR
Zip : 71653-6049
Country : US
Telephone Number : 870-265-5343
Fax Number : 870-265-5686
Provider Business Practice Location Address
First Line : 14116 CUSTOMS BLVD
Second Line :
City : GULFPORT
State : MS
Zip : 39503-5164
Country : US
Telephone Number : 833-362-6703
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/20/2006
Last Update Date : 12/18/2019

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