Provider Demographics
NPI:1790399087
Name:BAILEY, JACQUELINE KAY X
Entity Type:Individual
Prefix:MS
First Name:JACQUELINE
Middle Name:KAY
Last Name:BAILEY
Suffix:X
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:JACQUELINE
Other - Middle Name:KAY
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1 AVENUE C STE 102
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WV
Mailing Address - Zip Code:25130-1100
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1 AVENUE C STE 110
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WV
Practice Address - Zip Code:25130-1100
Practice Address - Country:US
Practice Address - Phone:304-369-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-03
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant