Provider Demographics
NPI:1437854825
Name:BAILEY-WILSON, ALECIA DT (NP)
Entity Type:Individual
Prefix:
First Name:ALECIA
Middle Name:DT
Last Name:BAILEY-WILSON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:447 S 8TH AVE
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:NY
Mailing Address - Zip Code:10550-4326
Mailing Address - Country:US
Mailing Address - Phone:718-312-2938
Mailing Address - Fax:
Practice Address - Street 1:447 S 8TH AVE
Practice Address - Street 2:
Practice Address - City:MOUNT VERNON
Practice Address - State:NY
Practice Address - Zip Code:10550-4326
Practice Address - Country:US
Practice Address - Phone:718-312-2938
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYA510645-01364SA2200X
NYF404318-01363LP0808X
NY510645-01163WP0809X
NY254091-01164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No163WP0809XNursing Service ProvidersRegistered NursePsychiatric/Mental Health, Adult
No164W00000XNursing Service ProvidersLicensed Practical Nurse