Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 22653 | CA |
NPI | 1043551609 |
---|---|
Provider Name | Amy Kathleen Bailey |
First Address | Hollister, CA 95023-6324 |
Second Address | Hollister, CA 95023-5651 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 07/03/2013 |
Last Update Date | 06/04/2016 |