Provider Demographics
NPI:1245237239
Name:BAGBY, ALAN D (RN/MICT)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:D
Last Name:BAGBY
Suffix:
Gender:M
Credentials:RN/MICT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 KAREN DR
Mailing Address - Street 2:
Mailing Address - City:HOLTON
Mailing Address - State:KS
Mailing Address - Zip Code:66436-1570
Mailing Address - Country:US
Mailing Address - Phone:785-364-4728
Mailing Address - Fax:
Practice Address - Street 1:105 KAREN DR
Practice Address - Street 2:
Practice Address - City:HOLTON
Practice Address - State:KS
Practice Address - Zip Code:66436-1570
Practice Address - Country:US
Practice Address - Phone:785-364-4728
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSMICT146L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes146L00000XEmergency Medical Service ProvidersEmergency Medical Technician, Paramedic