Provider Demographics
NPI:1356509988
Name:BAGGETT, BOBBIE JEAN (PA)
Entity Type:Individual
Prefix:
First Name:BOBBIE
Middle Name:JEAN
Last Name:BAGGETT
Suffix:
Gender:F
Credentials:PA
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 939
Mailing Address - Street 2:
Mailing Address - City:LA MARQUE
Mailing Address - State:TX
Mailing Address - Zip Code:77568-0939
Mailing Address - Country:US
Mailing Address - Phone:409-949-3406
Mailing Address - Fax:409-949-3492
Practice Address - Street 1:9850-C EMMETT F. LOWRY EXPY
Practice Address - Street 2:SUITE C-102
Practice Address - City:TEXAS CITY
Practice Address - State:TX
Practice Address - Zip Code:77591
Practice Address - Country:US
Practice Address - Phone:409-949-3406
Practice Address - Fax:409-949-3492
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-30
Last Update Date:2012-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA05625363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant