Provider Demographics
NPI:1790441533
Name:MOORE, BAILEY S (PA)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:S
Last Name:MOORE
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:29 TAYLOR AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CROSSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38555-4536
Mailing Address - Country:US
Mailing Address - Phone:931-484-6061
Mailing Address - Fax:931-484-6062
Practice Address - Street 1:29 TAYLOR AVE STE 101
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-4536
Practice Address - Country:US
Practice Address - Phone:931-484-6061
Practice Address - Fax:931-484-6062
Is Sole Proprietor?:No
Enumeration Date:2021-11-16
Last Update Date:2021-11-16
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TN4800363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant