Provider Demographics
NPI:1477333060
Name:BAISDEN, ANCIL
Entity Type:Individual
Prefix:
First Name:ANCIL
Middle Name:
Last Name:BAISDEN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:387 VICKERS BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:CHAPMANVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:25508-7554
Mailing Address - Country:US
Mailing Address - Phone:304-784-3351
Mailing Address - Fax:
Practice Address - Street 1:387 VICKERS BRANCH RD
Practice Address - Street 2:
Practice Address - City:CHAPMANVILLE
Practice Address - State:WV
Practice Address - Zip Code:25508-7554
Practice Address - Country:US
Practice Address - Phone:304-784-3351
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-10-02
Last Update Date:2023-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker