Provider Demographics
NPI:1417209784
Name:BAILES, KRISTIN GAIL (FNP-C)
Entity Type:Individual
Prefix:
First Name:KRISTIN
Middle Name:GAIL
Last Name:BAILES
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 CHESTNUT HILL RD
Mailing Address - Street 2:
Mailing Address - City:SUMMERSVILLE
Mailing Address - State:WV
Mailing Address - Zip Code:26651-1856
Mailing Address - Country:US
Mailing Address - Phone:304-619-8282
Mailing Address - Fax:
Practice Address - Street 1:110 PANTHER CREEK ROAD
Practice Address - Street 2:
Practice Address - City:NETTIE
Practice Address - State:WV
Practice Address - Zip Code:26681
Practice Address - Country:US
Practice Address - Phone:304-846-2484
Practice Address - Fax:304-226-3274
Is Sole Proprietor?:No
Enumeration Date:2012-10-10
Last Update Date:2023-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVF0712319363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily