Provider Demographics
NPI:1962404566
Name:BAXTER, KATHRYN (NP)
Entity type:Individual
Prefix:MS
First Name:KATHRYN
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 95000-2401
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19195-2401
Mailing Address - Country:US
Mailing Address - Phone:212-523-8069
Mailing Address - Fax:212-523-8857
Practice Address - Street 1:425 W 59TH ST
Practice Address - Street 2:SUITE 7B
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10019-8022
Practice Address - Country:US
Practice Address - Phone:212-523-8069
Practice Address - Fax:212-523-8857
Is Sole Proprietor?:No
Enumeration Date:2005-08-12
Last Update Date:2012-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF332158363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02073678Medicaid
NYS54538Medicare UPIN
NY95V421Medicare ID - Type Unspecified