Provider Demographics
NPI:1184663445
Name:BAILEY, MICHAEL S (FNP-BC)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:S
Last Name:BAILEY
Suffix:
Gender:M
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:9 CAREY RD
Mailing Address - Street 2:
Mailing Address - City:QUEENSBURY
Mailing Address - State:NY
Mailing Address - Zip Code:12804-7880
Mailing Address - Country:US
Mailing Address - Phone:518-761-0300
Mailing Address - Fax:518-824-2388
Practice Address - Street 1:3767 MAIN ST
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:NY
Practice Address - Zip Code:12885-1890
Practice Address - Country:US
Practice Address - Phone:518-623-2844
Practice Address - Fax:518-623-3416
Is Sole Proprietor?:No
Enumeration Date:2006-06-05
Last Update Date:2022-04-04
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
NYF334763363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02776465Medicaid
Q69611Medicare UPIN
NY02776465Medicaid
NY61915080OtherDOH COMMERCE ACCOUNTS MANAGEMENT UNIT (CAMU)
NYKAPPA GAMMAOtherSIGMA THETA TAU INTERNATIONAL