Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | 161119 | CO |
NPI | 1003936121 |
---|---|
Provider Name | Keri Bailey |
First Address | Glendale, CO 80246-1912 |
Second Address | Denver, CO 80218-1291 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/03/2007 |
Last Update Date | 16/05/2008 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
04901363 | MEDICAID PRACTICE NUMBER (01) | CO |
15380840 | (05) | CO |
37402552 | MEDICAID PRACTICE NUMBER (01) | CO |
54552826 | MEDICAID PRACTICE NUMBER (01) | CO |
809609 | MEDICARE GROUP PTAN (01) | CO |
C809609 | MEDICARE GROUP NUMBER (01) | CO |