Provider Demographics
NPI:1972961266
Name:BAXTER, SOPHIE (PA)
Entity type:Individual
Prefix:
First Name:SOPHIE
Middle Name:
Last Name:BAXTER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:300 3RD ST
Mailing Address - Street 2:
Mailing Address - City:RAWLINS
Mailing Address - State:WY
Mailing Address - Zip Code:82301-5612
Mailing Address - Country:US
Mailing Address - Phone:307-324-8494
Mailing Address - Fax:
Practice Address - Street 1:300 3RD ST
Practice Address - Street 2:
Practice Address - City:RAWLINS
Practice Address - State:WY
Practice Address - Zip Code:82301-5612
Practice Address - Country:US
Practice Address - Phone:307-324-8494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-02
Last Update Date:2025-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYPA1187363AM0700X
CO00000363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical