Provider Demographics
NPI:1063659043
Name:BAXTER, JENNIFER BAILEY (APHN, BSN)
Entity Type:Individual
Prefix:MS
First Name:JENNIFER
Middle Name:BAILEY
Last Name:BAXTER
Suffix:
Gender:F
Credentials:APHN, BSN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 STUART ST
Mailing Address - Street 2:MONCRIEF ARMY COMMUNITY HOSPITAL ATTN: CREDENTIALS
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29207-5700
Mailing Address - Country:US
Mailing Address - Phone:803-751-6931
Mailing Address - Fax:
Practice Address - Street 1:4500 STUART ST
Practice Address - Street 2:MONCRIEF ARMY COMMUNITY HOSPITAL/CREDENTIALS
Practice Address - City:COLUMBIA
Practice Address - State:SC
Practice Address - Zip Code:29207-5700
Practice Address - Country:US
Practice Address - Phone:803-751-6931
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-01-14
Last Update Date:2009-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN185528163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health