Provider Demographics
NPI:1568075919
Name:BAXLEY, VICTORIA LYNN
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:LYNN
Last Name:BAXLEY
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 1:2844 SPRINGDALE RD
Mailing Address - Street 2:
Mailing Address - City:MEADOW BRIDGE
Mailing Address - State:WV
Mailing Address - Zip Code:25976-6954
Mailing Address - Country:US
Mailing Address - Phone:304-575-9926
Mailing Address - Fax:
Practice Address - Street 1:2844 SPRINGDALE RD
Practice Address - Street 2:
Practice Address - City:MEADOW BRIDGE
Practice Address - State:WV
Practice Address - Zip Code:25976-6954
Practice Address - Country:US
Practice Address - Phone:304-575-9926
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2022-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant