Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | R873439 | MS |
NPI | 1013941970 |
---|---|
Provider Name | Mrs. Elizabeth Ewing Bailey |
First Address | Tupelo, MS 38801-4749 |
Second Address | Tupelo, MS 38801-4749 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/07/2006 |
Last Update Date | 03/03/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
08124226 | (05) | MS |