Provider Demographics
NPI:1043911803
Name:MCCANE, BAILLIE (APRN, PMHNP)
Entity Type:Individual
Prefix:
First Name:BAILLIE
Middle Name:
Last Name:MCCANE
Suffix:
Gender:F
Credentials:APRN, PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:205 NORTHRIDGE RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:KY
Mailing Address - Zip Code:40444-7092
Mailing Address - Country:US
Mailing Address - Phone:270-703-0876
Mailing Address - Fax:
Practice Address - Street 1:205 NORTHRIDGE RD
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:KY
Practice Address - Zip Code:40444-7092
Practice Address - Country:US
Practice Address - Phone:270-703-0876
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-16
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018387363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health