Individual
RANDALL KEITH BAXTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DNP
Contact information
Practice address
777 AVENUE H, POWELL, WY 82435-2260
(307) 754-2267
Mailing address
777 AVENUE H, POWELL, WY 82435-2260
(307) 754-2267
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
44753
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
44753
WYOMING STATE APRN LICENSE NUMBER
WY
Enumeration date
10/15/2019
Last updated
10/15/2019
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