Provider Demographics
NPI:1952323321
Name:BAXLEY, SHARON G (FNP)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:G
Last Name:BAXLEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N. ELM ST.
Mailing Address - Street 2:
Mailing Address - City:LUMBERTON
Mailing Address - State:NC
Mailing Address - Zip Code:28358-3011
Mailing Address - Country:US
Mailing Address - Phone:910-272-3051
Mailing Address - Fax:910-738-3764
Practice Address - Street 1:9928 N. W. R. LATHAN ST.
Practice Address - Street 2:
Practice Address - City:CLARKTON
Practice Address - State:NC
Practice Address - Zip Code:28433-0095
Practice Address - Country:US
Practice Address - Phone:910-647-1503
Practice Address - Fax:910-647-1505
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2012-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200796363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCP40062Medicare UPIN
NC2804798BMedicare ID - Type UnspecifiedCIGNA/MEDICARE