Provider Demographics
NPI:1811314909
Name:BAXTER, BRANDI (CNP)
Entity type:Individual
Prefix:
First Name:BRANDI
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1245 S UTICA AVE
Mailing Address - Street 2:SUITE 103
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74104-4214
Mailing Address - Country:US
Mailing Address - Phone:918-579-3840
Mailing Address - Fax:918-579-3849
Practice Address - Street 1:1245 S UTICA AVE
Practice Address - Street 2:SUITE 103
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74104-4214
Practice Address - Country:US
Practice Address - Phone:918-579-3840
Practice Address - Fax:918-579-3849
Is Sole Proprietor?:No
Enumeration Date:2014-03-26
Last Update Date:2016-04-14
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK96038363LA2200X, 363LG0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology