Provider Demographics
NPI:1396722146
Name:BAXTER, KIMBERLY VAIL (MD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:VAIL
Last Name:BAXTER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9835 N LAKE CREEK PKWY STE 120
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78717-6210
Mailing Address - Country:US
Mailing Address - Phone:737-229-3400
Mailing Address - Fax:737-229-3401
Practice Address - Street 1:9835 N LAKE CREEK PKWY STE 120
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78717-6210
Practice Address - Country:US
Practice Address - Phone:737-229-3400
Practice Address - Fax:737-229-3401
Is Sole Proprietor?:No
Enumeration Date:2005-12-22
Last Update Date:2024-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXJ8435208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX102963901Medicaid
TXG74184Medicare UPIN
TX82710KMedicare PIN
TX370013764Medicare PIN