Provider Demographics
NPI:1821539370
Name:BAILEY, SHRILDA GRADNEY (FAMILY NURSE PRACTIT)
Entity Type:Individual
Prefix:MRS
First Name:SHRILDA
Middle Name:GRADNEY
Last Name:BAILEY
Suffix:
Gender:F
Credentials:FAMILY NURSE PRACTIT
Other - Prefix:MRS
Other - First Name:SHRILDA
Other - Middle Name:ANN
Other - Last Name:BAILEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FAMILY NURSE PRACTIT
Mailing Address - Street 1:1308 GREEN OAK DR
Mailing Address - Street 2:N/A
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70815-2026
Mailing Address - Country:US
Mailing Address - Phone:817-291-9019
Mailing Address - Fax:225-412-4952
Practice Address - Street 1:1308 GREEN OAK DR
Practice Address - Street 2:N/A
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70815-2026
Practice Address - Country:US
Practice Address - Phone:817-291-9019
Practice Address - Fax:225-412-4952
Is Sole Proprietor?:No
Enumeration Date:2017-03-16
Last Update Date:2018-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LARN087065163W00000X
TXAP138674363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
LARN087065OtherREGISTERED NURSE LICENSE