Provider Demographics
NPI:1043222086
Name:BAILEY, PAMELA D (PA-C)
Entity Type:Individual
Prefix:
First Name:PAMELA
Middle Name:D
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1430
Mailing Address - Street 2:
Mailing Address - City:HARRISONBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22803-1430
Mailing Address - Country:US
Mailing Address - Phone:540-564-5622
Mailing Address - Fax:757-579-8594
Practice Address - Street 1:1790 E MARKET ST STE 64B
Practice Address - Street 2:
Practice Address - City:HARRISONBURG
Practice Address - State:VA
Practice Address - Zip Code:22801-5197
Practice Address - Country:US
Practice Address - Phone:540-564-5622
Practice Address - Fax:757-579-8594
Is Sole Proprietor?:No
Enumeration Date:2006-08-11
Last Update Date:2019-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110840225363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA1043222086Medicaid
VA1043222086Medicaid