Provider Demographics
NPI:1639642325
Name:BAXTER, SIERRA DAWN (PA-C)
Entity Type:Individual
Prefix:
First Name:SIERRA
Middle Name:DAWN
Last Name:BAXTER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:545 SEASHORE DR
Mailing Address - Street 2:
Mailing Address - City:ATLANTIC
Mailing Address - State:NC
Mailing Address - Zip Code:28511-9792
Mailing Address - Country:US
Mailing Address - Phone:252-269-9662
Mailing Address - Fax:
Practice Address - Street 1:147 HWY-24
Practice Address - Street 2:SUITE 102
Practice Address - City:MOREHEAD CITY
Practice Address - State:NC
Practice Address - Zip Code:28557
Practice Address - Country:US
Practice Address - Phone:252-726-4000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-06
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC0010-11817363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical