Provider Demographics
NPI:1376121079
Name:BAILEY, MISTY DAWN (FNP-C)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:DAWN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1330 COSHOCTON AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:OH
Mailing Address - Zip Code:43050-1495
Mailing Address - Country:US
Mailing Address - Phone:740-393-9000
Mailing Address - Fax:740-399-3115
Practice Address - Street 1:1330 COSHOCTON AVE FL 4
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:OH
Practice Address - Zip Code:43050-1495
Practice Address - Country:US
Practice Address - Phone:740-393-9000
Practice Address - Fax:740-399-3115
Is Sole Proprietor?:No
Enumeration Date:2021-04-01
Last Update Date:2021-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.0029008363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily