Provider Demographics
NPI:1497462501
Name:BAYLESS, MOLLY ANNE
Entity Type:Individual
Prefix:
First Name:MOLLY
Middle Name:ANNE
Last Name:BAYLESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MOLLY
Other - Middle Name:ANNE
Other - Last Name:BROWNELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7833 S UNION AVE APT 1818
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74132-2760
Mailing Address - Country:US
Mailing Address - Phone:319-775-7511
Mailing Address - Fax:
Practice Address - Street 1:7833 S UNION AVE APT 1818
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74132-2760
Practice Address - Country:US
Practice Address - Phone:319-775-7511
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-31
Last Update Date:2022-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program