Provider Demographics
NPI:1326763475
Name:BAILEY, JAVONTE LEXUS
Entity Type:Individual
Prefix:
First Name:JAVONTE
Middle Name:LEXUS
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 FERNANDO CT
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-4566
Mailing Address - Country:US
Mailing Address - Phone:504-450-7388
Mailing Address - Fax:
Practice Address - Street 1:2100 FERNANDO CT
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4566
Practice Address - Country:US
Practice Address - Phone:504-450-7388
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2022-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA376J00000X
LA089127649376J00000X
376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker