Provider Demographics
NPI:1467572867
Name:DEBRA R. BAILEY MD, FAAP, PSC
Entity Type:Organization
Organization Name:DEBRA R. BAILEY MD, FAAP, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MRS
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:606-437-1511
Mailing Address - Street 1:PO BOX 1255
Mailing Address - Street 2:
Mailing Address - City:PIKEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:41502-1255
Mailing Address - Country:US
Mailing Address - Phone:606-437-1511
Mailing Address - Fax:606-437-1626
Practice Address - Street 1:419 TOWN MOUNTAIN ROAD
Practice Address - Street 2:SUITE 202
Practice Address - City:PIKEVILLE
Practice Address - State:KY
Practice Address - Zip Code:41501-1633
Practice Address - Country:US
Practice Address - Phone:606-437-1511
Practice Address - Fax:606-437-1626
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2012-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY24703208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY64247034Medicaid
KY65905630Medicaid