Provider Demographics
NPI:1639207764
Name:BURNETTE-BAILEY, VICKI ELAINE (BA)
Entity Type:Individual
Prefix:MS
First Name:VICKI
Middle Name:ELAINE
Last Name:BURNETTE-BAILEY
Suffix:
Gender:F
Credentials:BA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:224 WILDWOOD DR
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-5528
Mailing Address - Country:US
Mailing Address - Phone:931-920-7345
Mailing Address - Fax:931-920-7332
Practice Address - Street 1:810 GREENWOOD AVE
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37040-4068
Practice Address - Country:US
Practice Address - Phone:931-920-7345
Practice Address - Fax:931-920-7345
Is Sole Proprietor?:No
Enumeration Date:2007-03-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator