Provider Demographics
NPI:1609644962
Name:STEPHENS, BAILEY MARIE (FNP-C)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:MARIE
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4999 CAROLINA FOREST BLVD STE 9
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29579-3587
Mailing Address - Country:US
Mailing Address - Phone:843-773-5888
Mailing Address - Fax:
Practice Address - Street 1:4999 CAROLINA FOREST BLVD STE 9
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29579-3587
Practice Address - Country:US
Practice Address - Phone:843-773-5888
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-18
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC28216363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily