Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | AP61168611 | WA |
Y | 363LP0808X | Nurse Practitioner - Psychiatric/Mental Health | AP61168611 | WA |
NPI | 1013581636 |
---|---|
Provider Name | Justin Clark Bayley |
First Address | Spokane, WA 99208-4736 |
Second Address | Spokane, WA 99218-1133 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/05/2021 |
Last Update Date | 09/08/2021 |