Provider Demographics
NPI:1275626681
Name:BALDWIN, KELLY TAYLOR (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:TAYLOR
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37284 SAINT MARIE AVE
Mailing Address - Street 2:
Mailing Address - City:PRAIRIEVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:70769-4492
Mailing Address - Country:US
Mailing Address - Phone:225-673-8135
Mailing Address - Fax:
Practice Address - Street 1:8601 SIEGEN LN
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70810-1943
Practice Address - Country:US
Practice Address - Phone:225-766-8803
Practice Address - Fax:225-766-8804
Is Sole Proprietor?:No
Enumeration Date:2006-09-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA15557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
0556050264Medicare ID - Type Unspecified
LA1206261Medicare ID - Type Unspecified