Provider Demographics
NPI:1871800409
Name:BAUGHER, VICKY T (CRNP)
Entity type:Individual
Prefix:
First Name:VICKY
Middle Name:T
Last Name:BAUGHER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 591
Mailing Address - Street 2:
Mailing Address - City:UNION BRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21791-0592
Mailing Address - Country:US
Mailing Address - Phone:443-937-6258
Mailing Address - Fax:949-404-6023
Practice Address - Street 1:104 N MAIN ST
Practice Address - Street 2:
Practice Address - City:UNION BRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21791-9102
Practice Address - Country:US
Practice Address - Phone:443-937-6258
Practice Address - Fax:949-404-6023
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2018-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR139731363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD19344200Medicaid