Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 1103114 | KS |
NPI | 1063436905 |
---|---|
Provider Name | Carrie Baxter |
First Address | Hutchinson, KS 67502-1106 |
Second Address | Hutchinson, KS 67502-1106 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 26/07/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
140554 | BCBS PROVIDER NO. (01) | KS |
140554 | DMERC PROVIDER NO. (01) | KS |
P00045246 | RR MEDICARE (01) | KS |
P68371 | (02) | KS |