Provider Demographics
NPI:1225592124
Name:LEFTWICH, BAILEY ANN (PA)
Entity Type:Individual
Prefix:MS
First Name:BAILEY
Middle Name:ANN
Last Name:LEFTWICH
Suffix:
Gender:F
Credentials:PA
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Mailing Address - Street 1:PO BOX 60352
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63160-0352
Mailing Address - Country:US
Mailing Address - Phone:314-747-0410
Mailing Address - Fax:877-991-8954
Practice Address - Street 1:4921 PARKVIEW PL
Practice Address - Street 2:DIV SURG HPB, STE 12B
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63110-1032
Practice Address - Country:US
Practice Address - Phone:314-747-0410
Practice Address - Fax:877-991-8954
Is Sole Proprietor?:No
Enumeration Date:2019-01-24
Last Update Date:2024-04-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2020033171363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO220091530Medicaid