Provider Demographics
NPI:1275634784
Name:BAISDEN, RALPH LEE JR (FNP)
Entity Type:Individual
Prefix:
First Name:RALPH
Middle Name:LEE
Last Name:BAISDEN
Suffix:JR
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:1409 W GEORGIA RD STE B
Practice Address - Street 2:
Practice Address - City:SIMPSONVILLE
Practice Address - State:SC
Practice Address - Zip Code:29680-6420
Practice Address - Country:US
Practice Address - Phone:864-454-5000
Practice Address - Fax:864-241-9231
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLARNP1175352363LF0000X
SC20736363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP4409Medicaid
FLP42907Medicare UPIN
FL0661650001Medicare NSC