Provider Demographics
NPI:1639544794
Name:BABY, SUSAN (NP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:BABY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3961 CREEKSIDE LN
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:TX
Mailing Address - Zip Code:75010-6398
Mailing Address - Country:US
Mailing Address - Phone:972-762-3033
Mailing Address - Fax:
Practice Address - Street 1:901 S MOPAC EXPRESSWAY
Practice Address - Street 2:BUILDING II SUITE 130
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78746-5776
Practice Address - Country:US
Practice Address - Phone:800-897-9177
Practice Address - Fax:800-470-8713
Is Sole Proprietor?:No
Enumeration Date:2015-12-01
Last Update Date:2015-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP128480363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXAP128480OtherSTATE LICENSE