Provider Demographics
NPI:1447431465
Name:BAILEY, JENNIFER CAIN (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:CAIN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:LYNNE
Other - Last Name:CAIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:415 S 28TH AVE
Mailing Address - Street 2:
Mailing Address - City:HATTIESBURG
Mailing Address - State:MS
Mailing Address - Zip Code:39401-7246
Mailing Address - Country:US
Mailing Address - Phone:601-268-5640
Mailing Address - Fax:601-579-5240
Practice Address - Street 1:421 S 28TH AVE
Practice Address - Street 2:
Practice Address - City:HATTIESBURG
Practice Address - State:MS
Practice Address - Zip Code:39401-7206
Practice Address - Country:US
Practice Address - Phone:601-268-5640
Practice Address - Fax:601-261-3507
Is Sole Proprietor?:No
Enumeration Date:2007-11-19
Last Update Date:2020-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS19973207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS00158064Medicaid
LA1327948Medicaid
MS9980178OtherAETNA
LA1327948Medicaid
MS512I160050Medicare PIN