Provider Demographics
NPI:1043692080
Name:BAGBY, MICHELLE LEIGH (DNP, FNP-C, APRN)
Entity Type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:LEIGH
Last Name:BAGBY
Suffix:
Gender:F
Credentials:DNP, FNP-C, APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12446 PRINCETON PIKE
Mailing Address - Street 2:
Mailing Address - City:PINE BLUFF
Mailing Address - State:AR
Mailing Address - Zip Code:71602-8566
Mailing Address - Country:US
Mailing Address - Phone:870-095-9492
Mailing Address - Fax:
Practice Address - Street 1:1101 S TENNESSEE ST
Practice Address - Street 2:
Practice Address - City:PINE BLUFF
Practice Address - State:AR
Practice Address - Zip Code:71601-5801
Practice Address - Country:US
Practice Address - Phone:705-432-3808
Practice Address - Fax:870-543-2368
Is Sole Proprietor?:No
Enumeration Date:2015-06-26
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA004416363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily