Provider Demographics
NPI:1376896670
Name:BAILEY, JEAN M (NP-C)
Entity Type:Individual
Prefix:
First Name:JEAN
Middle Name:M
Last Name:BAILEY
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:JEAN
Other - Middle Name:M
Other - Last Name:NITZSCHE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP
Mailing Address - Street 1:602 E 72ND ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-4913
Mailing Address - Country:US
Mailing Address - Phone:912-819-7878
Mailing Address - Fax:912-819-7850
Practice Address - Street 1:10 DOCTORS ST
Practice Address - Street 2:
Practice Address - City:METTER
Practice Address - State:GA
Practice Address - Zip Code:30439-3337
Practice Address - Country:US
Practice Address - Phone:912-685-5715
Practice Address - Fax:912-685-3461
Is Sole Proprietor?:No
Enumeration Date:2012-10-24
Last Update Date:2016-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN092042363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA003128721BMedicaid