Provider Demographics
NPI:1710663992
Name:HOLDER, BAILEY MILES (FNP-BC)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:MILES
Last Name:HOLDER
Suffix:
Gender:F
Credentials:FNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3248 RIVER POINTE CIR
Mailing Address - Street 2:
Mailing Address - City:KODAK
Mailing Address - State:TN
Mailing Address - Zip Code:37764-2361
Mailing Address - Country:US
Mailing Address - Phone:865-696-5023
Mailing Address - Fax:
Practice Address - Street 1:3248 RIVER POINTE CIR
Practice Address - Street 2:
Practice Address - City:KODAK
Practice Address - State:TN
Practice Address - Zip Code:37764-2361
Practice Address - Country:US
Practice Address - Phone:865-696-5023
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-23
Last Update Date:2024-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34148363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily