Provider Demographics
NPI:1316364334
Name:BAXLEY, STEPHEN TERRY JR (ARNP)
Entity type:Individual
Prefix:
First Name:STEPHEN
Middle Name:TERRY
Last Name:BAXLEY
Suffix:JR
Gender:
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2109 OYSTER HARBOUR PKWY SW
Mailing Address - Street 2:
Mailing Address - City:SUPPLY
Mailing Address - State:NC
Mailing Address - Zip Code:28462-3074
Mailing Address - Country:US
Mailing Address - Phone:910-725-9496
Mailing Address - Fax:
Practice Address - Street 1:6310 BEACH DR SW
Practice Address - Street 2:
Practice Address - City:OCEAN ISLE BEACH
Practice Address - State:NC
Practice Address - Zip Code:28469-4732
Practice Address - Country:US
Practice Address - Phone:910-833-9470
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-27
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3008586363LF0000X
NC5009521363LF0000X
SC29721363LF0000X
TN18173363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily