Provider Demographics
NPI:1316416092
Name:BAILEY, KRISTINA (PHYSICIAN ASSISTANT)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PHYSICIAN ASSISTANT
Other - Prefix:
Other - First Name:KRISTINA
Other - Middle Name:
Other - Last Name:THOMPSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:103 ENCHANTED HILLS RD APT 203
Mailing Address - Street 2:
Mailing Address - City:OWINGS MILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21117-3022
Mailing Address - Country:US
Mailing Address - Phone:443-480-0301
Mailing Address - Fax:
Practice Address - Street 1:5 BEL AIR SOUTH PKWY STE 1535
Practice Address - Street 2:
Practice Address - City:BEL AIR
Practice Address - State:MD
Practice Address - Zip Code:21015-3816
Practice Address - Country:US
Practice Address - Phone:410-569-0044
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-25
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0007077363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant