Provider Demographics
NPI:1083330914
Name:BAILEY, JONATHAN (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:JONATHAN
Middle Name:
Last Name:BAILEY
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:543 POWELL LN
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:KY
Mailing Address - Zip Code:42025-5366
Mailing Address - Country:US
Mailing Address - Phone:270-415-7070
Mailing Address - Fax:270-415-7071
Practice Address - Street 1:543 POWELL LN
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:KY
Practice Address - Zip Code:42025-5366
Practice Address - Country:US
Practice Address - Phone:270-415-7070
Practice Address - Fax:270-415-7071
Is Sole Proprietor?:No
Enumeration Date:2022-10-12
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018519363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily