Provider Demographics
NPI:1326681875
Name:BAXTER, TABITHA L (LVN)
Entity Type:Individual
Prefix:
First Name:TABITHA
Middle Name:L
Last Name:BAXTER
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:TABITHA
Other - Middle Name:
Other - Last Name:MURPHEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:184 BRAZOS VALLEY LN
Mailing Address - Street 2:
Mailing Address - City:WEATHERFORD
Mailing Address - State:TX
Mailing Address - Zip Code:76087-6647
Mailing Address - Country:US
Mailing Address - Phone:940-399-7346
Mailing Address - Fax:
Practice Address - Street 1:184 BRAZOS VALLEY LN
Practice Address - Street 2:
Practice Address - City:WEATHERFORD
Practice Address - State:TX
Practice Address - Zip Code:76087-6647
Practice Address - Country:US
Practice Address - Phone:940-399-7346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-10-28
Last Update Date:2019-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX203258164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse