Provider Demographics
NPI:1114545282
Name:BAILEY, KATLYN LOUISE (RN)
Entity Type:Individual
Prefix:
First Name:KATLYN
Middle Name:LOUISE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:117 3RD ST
Mailing Address - Street 2:
Mailing Address - City:GRACETON
Mailing Address - State:PA
Mailing Address - Zip Code:15748-7114
Mailing Address - Country:US
Mailing Address - Phone:724-541-7190
Mailing Address - Fax:
Practice Address - Street 1:429 MANOR DR STE 10
Practice Address - Street 2:
Practice Address - City:EBENSBURG
Practice Address - State:PA
Practice Address - Zip Code:15931-4917
Practice Address - Country:US
Practice Address - Phone:814-472-6050
Practice Address - Fax:814-472-1293
Is Sole Proprietor?:No
Enumeration Date:2020-07-06
Last Update Date:2020-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARN722668163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse