Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207PP0204X | Pediatric Emergency Physician | 63489 | WI |
N | 207PP0204X | Pediatric Emergency Physician | MD61142499 | WA |
Y | 208000000X | Pediatrician | MD.61142499 | WA |
NPI | 1629311477 |
---|---|
Provider Name | Kelly Bailey |
First Address | Spokane, WA 99210-0383 |
Second Address | Spokane, WA 99204-2307 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2013 |
Last Update Date | 24/06/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1629311477 | (05) | WI |