Provider Demographics
NPI:1689935249
Name:BAILEY, ERIC P (APRNCNP)
Entity Type:Individual
Prefix:
First Name:ERIC
Middle Name:P
Last Name:BAILEY
Suffix:
Gender:M
Credentials:APRNCNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:700 ACKERMAN RD STE 2120
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43202-1559
Mailing Address - Country:US
Mailing Address - Phone:937-599-6105
Mailing Address - Fax:
Practice Address - Street 1:2220 TIMBER TRL
Practice Address - Street 2:
Practice Address - City:BELLEFONTAINE
Practice Address - State:OH
Practice Address - Zip Code:43311-9039
Practice Address - Country:US
Practice Address - Phone:937-599-6105
Practice Address - Fax:937-592-7500
Is Sole Proprietor?:No
Enumeration Date:2012-05-30
Last Update Date:2021-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.023995363L00000X
IL209000139363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute CareGroup - Single Specialty
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty