Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | R877157 | MS |
NPI | 1003161373 |
---|---|
Provider Name | Amy Bailey |
First Address | Amory, MS 38821-5507 |
Second Address | Amory, MS 38821-5507 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 23/07/2012 |
Last Update Date | 03/10/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
R877157 | MISSISSIPPI BOARD OF NURSING (01) | MS |