Provider Demographics
NPI:1902837230
Name:JEFFRIES-BAXTER, ROXANNE (NP)
Entity type:Individual
Prefix:
First Name:ROXANNE
Middle Name:
Last Name:JEFFRIES-BAXTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2212 RONALD DR
Mailing Address - Street 2:
Mailing Address - City:EAGLEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:19403-1353
Mailing Address - Country:US
Mailing Address - Phone:267-307-2077
Mailing Address - Fax:
Practice Address - Street 1:840 FIRST AVE STE 400
Practice Address - Street 2:
Practice Address - City:KING OF PRUSSIA
Practice Address - State:PA
Practice Address - Zip Code:19406-4062
Practice Address - Country:US
Practice Address - Phone:610-934-2200
Practice Address - Fax:610-885-0801
Is Sole Proprietor?:No
Enumeration Date:2006-07-05
Last Update Date:2024-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PATP004933H363LG0600X
PASP011634363LF0000X
PASP022178363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily