Provider Demographics
NPI:1164149647
Name:BAXTER, MARIBETH
Entity Type:Individual
Prefix:
First Name:MARIBETH
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 172
Mailing Address - Street 2:
Mailing Address - City:SAINT JO
Mailing Address - State:TX
Mailing Address - Zip Code:76265-0172
Mailing Address - Country:US
Mailing Address - Phone:940-736-8389
Mailing Address - Fax:
Practice Address - Street 1:303 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:SAINT JO
Practice Address - State:TX
Practice Address - Zip Code:76265
Practice Address - Country:US
Practice Address - Phone:940-736-8389
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-25
Last Update Date:2022-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach