Provider Demographics
NPI:1598762825
Name:BAILEY, AGNA ELIZABETH (DO)
Entity Type:Individual
Prefix:
First Name:AGNA
Middle Name:ELIZABETH
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:A
Other - Middle Name:ELIZABETH
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DO
Mailing Address - Street 1:101 CROWN POINTE BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:WILLOW PARK
Mailing Address - State:TX
Mailing Address - Zip Code:76087-1191
Mailing Address - Country:US
Mailing Address - Phone:817-599-7661
Mailing Address - Fax:817-599-8408
Practice Address - Street 1:101 CROWN POINTE BLVD STE 200
Practice Address - Street 2:
Practice Address - City:WILLOW PARK
Practice Address - State:TX
Practice Address - Zip Code:76087-1191
Practice Address - Country:US
Practice Address - Phone:817-599-7661
Practice Address - Fax:817-599-8408
Is Sole Proprietor?:No
Enumeration Date:2005-07-01
Last Update Date:2022-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL5037207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8EU779OtherBCBS
TX173166303Medicaid
TX1731663001Medicaid
7276626OtherAETNA
TX1731663001Medicaid
TXI25385Medicare UPIN