Provider Demographics
NPI:1912247248
Name:BALDWIN, KATINA YVETTE (FNP)
Entity Type:Individual
Prefix:
First Name:KATINA
Middle Name:YVETTE
Last Name:BALDWIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATINA
Other - Middle Name:YVETTE
Other - Last Name:CARROLL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3030 E 29TH ST
Mailing Address - Street 2:SUITE 111
Mailing Address - City:BRYAN
Mailing Address - State:TX
Mailing Address - Zip Code:77802-2757
Mailing Address - Country:US
Mailing Address - Phone:979-774-4176
Mailing Address - Fax:979-774-4180
Practice Address - Street 1:3030 E 29TH ST
Practice Address - Street 2:SUITE 111
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2757
Practice Address - Country:US
Practice Address - Phone:979-774-4176
Practice Address - Fax:979-774-4180
Is Sole Proprietor?:Yes
Enumeration Date:2013-02-23
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX736912363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily