Provider Demographics
NPI:1598201972
Name:BAYLESS, JEFFREY WRIGHT
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:WRIGHT
Last Name:BAYLESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11885 CLAIM STAKE DR
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89506-7540
Mailing Address - Country:US
Mailing Address - Phone:512-436-5841
Mailing Address - Fax:775-339-0105
Practice Address - Street 1:515 COURT ST
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89501-1710
Practice Address - Country:US
Practice Address - Phone:775-410-0189
Practice Address - Fax:775-339-0105
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-10
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP132794363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health