Provider Demographics
NPI:1063436905
Name:BAXTER, CARRIE (RPT)
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:RPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 E 23RD AVE
Mailing Address - Street 2:
Mailing Address - City:HUTCHINSON
Mailing Address - State:KS
Mailing Address - Zip Code:67502-1106
Mailing Address - Country:US
Mailing Address - Phone:620-662-6000
Mailing Address - Fax:620-669-2394
Practice Address - Street 1:1818 E 23RD AVE
Practice Address - Street 2:
Practice Address - City:HUTCHINSON
Practice Address - State:KS
Practice Address - Zip Code:67502-1106
Practice Address - Country:US
Practice Address - Phone:620-662-6000
Practice Address - Fax:620-669-2394
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1103114208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS140554OtherBCBS PROVIDER NO.
KS140554OtherDMERC PROVIDER NO.
KSP00045246OtherRR MEDICARE
KSP68371Medicare UPIN
KS140554OtherBCBS PROVIDER NO.