Provider Demographics
NPI:1740807379
Name:DONALDSON, BAYLI NIKOLE (PA-C)
Entity Type:Individual
Prefix:
First Name:BAYLI
Middle Name:NIKOLE
Last Name:DONALDSON
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:5401 N PORTLAND AVE STE 600
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-2121
Mailing Address - Country:US
Mailing Address - Phone:405-713-9940
Mailing Address - Fax:405-713-9941
Practice Address - Street 1:5401 N PORTLAND AVE STE 600
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2121
Practice Address - Country:US
Practice Address - Phone:405-713-9940
Practice Address - Fax:405-713-9941
Is Sole Proprietor?:No
Enumeration Date:2020-06-30
Last Update Date:2021-09-02
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
OK3201363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant