Provider Demographics
NPI:1598450470
Name:HAMILTON, BAILEE MICHELLE (NP)
Entity Type:Individual
Prefix:
First Name:BAILEE
Middle Name:MICHELLE
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5253 N CANYON RD
Mailing Address - Street 2:
Mailing Address - City:PROVO
Mailing Address - State:UT
Mailing Address - Zip Code:84604-5432
Mailing Address - Country:US
Mailing Address - Phone:928-890-7869
Mailing Address - Fax:
Practice Address - Street 1:159 N 400 W STE B-8
Practice Address - Street 2:
Practice Address - City:OREM
Practice Address - State:UT
Practice Address - Zip Code:84057-1909
Practice Address - Country:US
Practice Address - Phone:385-262-4135
Practice Address - Fax:801-899-7996
Is Sole Proprietor?:No
Enumeration Date:2023-04-07
Last Update Date:2023-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10348389-4405363LF0000X, 363L00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program