Provider Demographics
NPI:1639473713
Name:BAILES, NIKKI ELIZABETH (CRNP)
Entity Type:Individual
Prefix:
First Name:NIKKI
Middle Name:ELIZABETH
Last Name:BAILES
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:NIKKI
Other - Middle Name:ELIZABETH
Other - Last Name:LEEDY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CRNP
Mailing Address - Street 1:3421 CONCORD RD
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17402-9001
Mailing Address - Country:US
Mailing Address - Phone:717-339-2790
Mailing Address - Fax:717-339-2771
Practice Address - Street 1:40 V TWIN DR
Practice Address - Street 2:
Practice Address - City:GETTYSBURG
Practice Address - State:PA
Practice Address - Zip Code:17325-7875
Practice Address - Country:US
Practice Address - Phone:717-339-2790
Practice Address - Fax:717-339-2771
Is Sole Proprietor?:No
Enumeration Date:2011-01-04
Last Update Date:2022-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV68690363LF0000X
PASP016243363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA526529FLTMedicare PIN