Provider Demographics
NPI:1467489021
Name:BAXTER, LINDA COCKRAM (RN PHD PMHNPCNS-BC)
Entity Type:Individual
Prefix:DR
First Name:LINDA
Middle Name:COCKRAM
Last Name:BAXTER
Suffix:
Gender:F
Credentials:RN PHD PMHNPCNS-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8518 CHESTER FOREST LN
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23237-2662
Mailing Address - Country:US
Mailing Address - Phone:804-221-5112
Mailing Address - Fax:
Practice Address - Street 1:9097 ATLEE STATION RD
Practice Address - Street 2:SUITE 219
Practice Address - City:MECHANICSVILLE
Practice Address - State:VA
Practice Address - Zip Code:23116-2525
Practice Address - Country:US
Practice Address - Phone:804-730-2829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-27
Last Update Date:2012-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024078127363LA2200X, 163WP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health