Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 2017032958 | MO |
NPI | 1003322009 |
---|---|
Provider Name | Bayley Nicole Little |
First Address | Perryville, MO 63775-2616 |
Second Address | Perryville, MO 63775-1231 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/12/2017 |
Last Update Date | 17/03/2018 |