Provider Demographics
NPI:1043966674
Name:JOHNSON-RAE, BAILEY JAY (FNP-C)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:JAY
Last Name:JOHNSON-RAE
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1011 CORSAIRE ST
Mailing Address - Street 2:
Mailing Address - City:LAKEWAY
Mailing Address - State:TX
Mailing Address - Zip Code:78734-4413
Mailing Address - Country:US
Mailing Address - Phone:512-762-1601
Mailing Address - Fax:
Practice Address - Street 1:1011 CORSAIRE ST
Practice Address - Street 2:
Practice Address - City:LAKEWAY
Practice Address - State:TX
Practice Address - Zip Code:78734-4413
Practice Address - Country:US
Practice Address - Phone:512-762-1601
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-22
Last Update Date:2022-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363LS0200X363LS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LS0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerSchool