Provider Demographics
NPI:1497922090
Name:BAILEY, MICHELLE A (RN, NP-C)
Entity Type:Individual
Prefix:MRS
First Name:MICHELLE
Middle Name:A
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11109 PARKVIEW PLAZA DR # 117
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46845-1701
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:11055 TWIN CREEKS CV
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46845-2204
Practice Address - Country:US
Practice Address - Phone:260-425-6120
Practice Address - Fax:260-425-6115
Is Sole Proprietor?:No
Enumeration Date:2008-05-13
Last Update Date:2022-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002670A363L00000X
IN28158098A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000000617878OtherANTHEM
IN200905320Medicaid
IN000000617879OtherANTHEM
IN184730HMedicare PIN
IN000000617878OtherANTHEM