Provider Demographics
NPI:1518627520
Name:BALDWIN, JIMMIE KAYE
Entity Type:Individual
Prefix:
First Name:JIMMIE
Middle Name:KAYE
Last Name:BALDWIN
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:PO BOX 73074
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99707-3074
Mailing Address - Country:US
Mailing Address - Phone:907-590-2070
Mailing Address - Fax:
Practice Address - Street 1:1606 ROOSEVELT ST
Practice Address - Street 2:
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5109
Practice Address - Country:US
Practice Address - Phone:907-590-2070
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-19
Last Update Date:2021-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator