Provider Demographics
NPI:1710012067
Name:BAILEY, ADELL
Entity Type:Individual
Prefix:
First Name:ADELL
Middle Name:
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 204
Mailing Address - Street 2:
Mailing Address - City:DERMOTT
Mailing Address - State:AR
Mailing Address - Zip Code:71638
Mailing Address - Country:US
Mailing Address - Phone:870-222-5534
Mailing Address - Fax:870-222-6741
Practice Address - Street 1:2410 HWY 65N
Practice Address - Street 2:
Practice Address - City:MCGHEE
Practice Address - State:AR
Practice Address - Zip Code:71654
Practice Address - Country:US
Practice Address - Phone:870-222-5534
Practice Address - Fax:870-222-6741
Is Sole Proprietor?:No
Enumeration Date:2007-02-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator