Provider Demographics
NPI:1578608170
Name:BAILEY, MARK WESLEY (FNP, DC)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:WESLEY
Last Name:BAILEY
Suffix:
Gender:M
Credentials:FNP, DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7097 N EXPY 77
Mailing Address - Street 2:STE 5
Mailing Address - City:OLMITO
Mailing Address - State:TX
Mailing Address - Zip Code:78575-9807
Mailing Address - Country:US
Mailing Address - Phone:956-518-7305
Mailing Address - Fax:956-518-7307
Practice Address - Street 1:7097 N EXPY 77
Practice Address - Street 2:STE 5
Practice Address - City:OLMITO
Practice Address - State:TX
Practice Address - Zip Code:78575-9807
Practice Address - Country:US
Practice Address - Phone:956-518-7305
Practice Address - Fax:956-518-7307
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2024-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDC6041111N00000X
TX776890363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXT0183616OtherDPS NUMBER
TX179628601Medicaid
TXT0183616OtherDPS NUMBER
TX179628601Medicaid
TXT0183616OtherDPS NUMBER
U39627Medicare UPIN