WYATT DALE BAXTER Physician Assistant License verification

Business Entity

ACTIVE

License Type

Physician Assistant

Description

PHYSICIAN ASSISTANT CONTROLLED SUBSTANCE

License Number

38*****19

License Status

ACTIVE

Business

First Name

WYATT

Middle

DALE

Last Name

BAXTER

Business Name

WYATT DALE BAXTER

Original Issue Date

10/26/2021

Effective Date

12/05/2025

Expiration Date

03/01/2028

City

TENNESSEE

State

Zip

62374

County

HANCOCK

Delegated Controlled Substance Schedule

II III IV V

Ever Disciplined

LastModifiedDate

12/05/2025