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
State | License ID | Taxonomies |
---|---|---|
WV | 49124 | 363LF0000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 363LF0000X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
WV | 3810002489 | Medicaid | |
KY | 78017209 | Medicaid | |
WV | 2034884 | Medicare PIN | |
WV | Q49600 | Medicare UPIN | |
WV | 2034883 | Medicare PIN | |
WV | BANP20662 | Medicare PIN | |
WV | 2034881 | Medicare PIN |