Provider Demographics
NPI:1073022158
Name:WILLIAMS-BAILEY, ROBIN SHANTA (NP)
Entity Type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:SHANTA
Last Name:WILLIAMS-BAILEY
Suffix:
Gender:F
Credentials:NP
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 2422
Mailing Address - Street 2:
Mailing Address - City:FAYETTE
Mailing Address - State:MS
Mailing Address - Zip Code:39069-2422
Mailing Address - Country:US
Mailing Address - Phone:601-809-0500
Mailing Address - Fax:601-809-0501
Practice Address - Street 1:225 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MS
Practice Address - Zip Code:39069-7701
Practice Address - Country:US
Practice Address - Phone:601-809-0500
Practice Address - Fax:601-809-0501
Is Sole Proprietor?:No
Enumeration Date:2017-09-21
Last Update Date:2023-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904683363LP0808X
TXAP135006363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health