Provider Demographics
NPI:1780649087
Name:BAISDEN, RACHEL SUE (CFNP)
Entity Type:Individual
Prefix:
First Name:RACHEL
Middle Name:SUE
Last Name:BAISDEN
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:47460 ROUTE 52
Mailing Address - Street 2:
Mailing Address - City:KERMIT
Mailing Address - State:WV
Mailing Address - Zip Code:25674-1138
Mailing Address - Country:US
Mailing Address - Phone:304-393-6901
Mailing Address - Fax:304-393-6904
Practice Address - Street 1:47460 ROUTE 52
Practice Address - Street 2:
Practice Address - City:KERMIT
Practice Address - State:WV
Practice Address - Zip Code:25674-8052
Practice Address - Country:US
Practice Address - Phone:304-393-6901
Practice Address - Fax:304-393-6904
Is Sole Proprietor?:No
Enumeration Date:2006-04-19
Last Update Date:2024-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV49124363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810002489Medicaid
KY78017209Medicaid
WV2034884Medicare PIN
WVQ49600Medicare UPIN
WV2034883Medicare PIN
WVBANP20662Medicare PIN
WV2034881Medicare PIN