Provider Demographics
NPI:1811409840
Name:BAXTER, JESSICA FERGUSON (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:FERGUSON
Last Name:BAXTER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:108 SADDLE BRK
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29625-5142
Mailing Address - Country:US
Mailing Address - Phone:864-940-9970
Mailing Address - Fax:
Practice Address - Street 1:109 CARTER PARK DR
Practice Address - Street 2:
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678-1152
Practice Address - Country:US
Practice Address - Phone:864-885-0058
Practice Address - Fax:864-885-0098
Is Sole Proprietor?:No
Enumeration Date:2017-10-31
Last Update Date:2017-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC21299207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine