Provider Demographics
NPI:1063013423
Name:BAILEY, TIMOTHY (PMHNP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:
Last Name:BAILEY
Suffix:
Gender:M
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2 S PARK ST
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:NH
Mailing Address - Zip Code:03766-1384
Mailing Address - Country:US
Mailing Address - Phone:603-865-7157
Mailing Address - Fax:603-709-2752
Practice Address - Street 1:2 S PARK ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:NH
Practice Address - Zip Code:03766-1384
Practice Address - Country:US
Practice Address - Phone:603-865-7157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-03
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH068623-23363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health