Provider Demographics
NPI:1235795857
Name:BAXTER, JACQUELINE (NCPRSS)
Entity Type:Individual
Prefix:
First Name:JACQUELINE
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:NCPRSS
Other - Prefix:MISS
Other - First Name:JACQUELINE
Other - Middle Name:
Other - Last Name:BAXTER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:JACQUELINE BAXTER
Mailing Address - Street 1:PO BOX 1224
Mailing Address - Street 2:
Mailing Address - City:NORRIS
Mailing Address - State:TN
Mailing Address - Zip Code:37828-1224
Mailing Address - Country:US
Mailing Address - Phone:865-247-5196
Mailing Address - Fax:
Practice Address - Street 1:17 RIDGEWAY RD
Practice Address - Street 2:
Practice Address - City:NORRIS
Practice Address - State:TN
Practice Address - Zip Code:37828
Practice Address - Country:US
Practice Address - Phone:865-247-5196
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-20
Last Update Date:2019-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist