Provider Demographics
NPI:1063844249
Name:PAXTON, BOBBY LEE (CFNP)
Entity Type:Individual
Prefix:MR
First Name:BOBBY
Middle Name:LEE
Last Name:PAXTON
Suffix:
Gender:M
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 E BAKER ST
Mailing Address - Street 2:
Mailing Address - City:INDIANOLA
Mailing Address - State:MS
Mailing Address - Zip Code:38751-2451
Mailing Address - Country:US
Mailing Address - Phone:662-887-2212
Mailing Address - Fax:662-887-1279
Practice Address - Street 1:122 E BAKER ST
Practice Address - Street 2:
Practice Address - City:INDIANOLA
Practice Address - State:MS
Practice Address - Zip Code:38751-2451
Practice Address - Country:US
Practice Address - Phone:662-887-2212
Practice Address - Fax:662-887-1279
Is Sole Proprietor?:No
Enumeration Date:2013-07-30
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR869787363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily