Provider Demographics
NPI:1518262013
Name:BAILEY, CHRISTINA ANN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:ANN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:CHRISTINA
Other - Middle Name:ANN
Other - Last Name:MAHONEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5 CENTERPOINTE DR
Mailing Address - Street 2:SUITE 600
Mailing Address - City:LAKE OSWEGO
Mailing Address - State:OR
Mailing Address - Zip Code:97035-8651
Mailing Address - Country:US
Mailing Address - Phone:503-349-5135
Mailing Address - Fax:855-878-2484
Practice Address - Street 1:5 CENTERPOINTE DR
Practice Address - Street 2:SUITE 600
Practice Address - City:LAKE OSWEGO
Practice Address - State:OR
Practice Address - Zip Code:97035-8651
Practice Address - Country:US
Practice Address - Phone:503-349-5135
Practice Address - Fax:855-878-2484
Is Sole Proprietor?:No
Enumeration Date:2011-01-14
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA159999363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500657872Medicaid
ORR168365Medicare PIN