Provider Demographics
NPI:1659464691
Name:BAILEY, DONNA LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DONNA
Middle Name:LYNN
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 BRIDGE CANYON CT
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75080-2600
Mailing Address - Country:US
Mailing Address - Phone:972-783-0915
Mailing Address - Fax:972-979-2226
Practice Address - Street 1:204 BRIDGE CANYON CT
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75080-2600
Practice Address - Country:US
Practice Address - Phone:972-783-0915
Practice Address - Fax:972-979-2226
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXPA03622363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TXPA03622OtherTX MEDICAL BOARD LICENSE
TX1012551OtherNCCPA CERTIFICATE #
TXPA7010OtherBCBS PROVIDER #
TX1012551OtherNCCPA CERTIFICATE #
TXPA7010OtherBCBS PROVIDER #