Provider Demographics
NPI:1639432461
Name:BAILEY, ELLOIS WILSON (DNP, APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:ELLOIS
Middle Name:WILSON
Last Name:BAILEY
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12760 S PARK AVE UNIT 216
Mailing Address - Street 2:
Mailing Address - City:RIVERTON
Mailing Address - State:UT
Mailing Address - Zip Code:84065-3409
Mailing Address - Country:US
Mailing Address - Phone:801-598-9812
Mailing Address - Fax:
Practice Address - Street 1:9035 S 1300 E STE 120
Practice Address - Street 2:
Practice Address - City:SANDY
Practice Address - State:UT
Practice Address - Zip Code:84094-3132
Practice Address - Country:US
Practice Address - Phone:801-455-0045
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-06-18
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT211181-4408363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health