Provider Demographics
NPI:1558098558
Name:WILSON, BAILEY (PA-C)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:WILSON
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:534 E 300 N UNIT 311
Mailing Address - Street 2:
Mailing Address - City:VINEYARD
Mailing Address - State:UT
Mailing Address - Zip Code:84059-3510
Mailing Address - Country:US
Mailing Address - Phone:206-819-0538
Mailing Address - Fax:
Practice Address - Street 1:534 E 300 N UNIT 311
Practice Address - Street 2:
Practice Address - City:VINEYARD
Practice Address - State:UT
Practice Address - Zip Code:84059-3510
Practice Address - Country:US
Practice Address - Phone:206-819-0538
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-01
Last Update Date:2022-09-16
Deactivation Date:2022-08-02
Deactivation Code:
Reactivation Date:2022-09-16
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant