Provider Demographics
NPI:1104713452
Name:ANGSTADT-BAILEY, KENNIDY GABRIELLE
Entity type:Individual
Prefix:
First Name:KENNIDY
Middle Name:GABRIELLE
Last Name:ANGSTADT-BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2395 BECHELLI LN STE B
Mailing Address - Street 2:
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96002-0156
Mailing Address - Country:US
Mailing Address - Phone:530-638-3811
Mailing Address - Fax:
Practice Address - Street 1:2395 BECHELLI LN STE B
Practice Address - Street 2:
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96002-0156
Practice Address - Country:US
Practice Address - Phone:530-638-3811
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-19
Last Update Date:2025-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program