Provider Demographics
NPI:1760496814
Name:BAILEY, KATHRYN SMITH (FNP)
Entity Type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:SMITH
Last Name:BAILEY
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:MS
Other - First Name:KATHRYN
Other - Middle Name:KELLY
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:1630 N JEFFERSON AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65803-2819
Mailing Address - Country:US
Mailing Address - Phone:417-837-1504
Mailing Address - Fax:417-837-1545
Practice Address - Street 1:1630 N JEFFERSON AVE
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-2819
Practice Address - Country:US
Practice Address - Phone:417-837-1504
Practice Address - Fax:417-837-1545
Is Sole Proprietor?:No
Enumeration Date:2006-07-27
Last Update Date:2013-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN182759363LF0000X
MO2013003462363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily