Provider Demographics
NPI:1780796631
Name:BAXLEY, CYNTHIA NICOLLE (WHNP)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:NICOLLE
Last Name:BAXLEY
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10943 TOPVIEW LANE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934
Mailing Address - Country:US
Mailing Address - Phone:865-621-5977
Mailing Address - Fax:
Practice Address - Street 1:9330 PARKWEST BLVD
Practice Address - Street 2:STE 302
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4311
Practice Address - Country:US
Practice Address - Phone:865-531-5878
Practice Address - Fax:865-531-7690
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2011-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000008309363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3495296Medicaid
TN4069212OtherBLUE CROSS BLUE SHIELD
TN100044403OtherCARITEN PREF HEALTH PTNSH