Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 363L00000X | Nurse Practitioner | 76112 | KS |
N | 363LA2100X | Nurse Practitioner - Acute Care | 76112 | KS |
N | 363LC0200X | Nurse Practitioner - Critical Care Medicine | 76112 | KS |
N | 363LC1500X | Nurse Practitioner - Community Health | 76112 | KS |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 76112 | KS |
N | 363LP0200X | Nurse Practitioner - Pediatrics | 76112 | KS |
NPI | 1467886275 |
---|---|
Provider Name | Mr. Brandon James Bailey |
First Address | Wichita, KS 67209-3528 |
Second Address | Ellinwood, KS 67526 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/08/2013 |
Last Update Date | 24/01/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
201088240A | (05) | KS |
76112 | KANSAS STATE LICENSE (01) | KS |