Provider Demographics
NPI:1467908731
Name:BAXTER, KIM
Entity Type:Individual
Prefix:
First Name:KIM
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1218 W STANLEY ROAD
Mailing Address - Street 2:
Mailing Address - City:MT MORRIS
Mailing Address - State:MI
Mailing Address - Zip Code:48458
Mailing Address - Country:US
Mailing Address - Phone:810-686-9109
Mailing Address - Fax:
Practice Address - Street 1:1218 W STANLEY ROAD
Practice Address - Street 2:
Practice Address - City:MT MORRIS
Practice Address - State:MI
Practice Address - Zip Code:48458
Practice Address - Country:US
Practice Address - Phone:810-686-9109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes247200000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Other