Provider Demographics
NPI:1821784455
Name:BAYLESS, ERIC TAD
Entity Type:Individual
Prefix:MR
First Name:ERIC
Middle Name:TAD
Last Name:BAYLESS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5914 SW 69TH ST
Mailing Address - Street 2:
Mailing Address - City:AUBURN
Mailing Address - State:KS
Mailing Address - Zip Code:66402-9688
Mailing Address - Country:US
Mailing Address - Phone:785-640-6844
Mailing Address - Fax:
Practice Address - Street 1:5914 SW 69TH ST
Practice Address - Street 2:
Practice Address - City:AUBURN
Practice Address - State:KS
Practice Address - Zip Code:66402-9688
Practice Address - Country:US
Practice Address - Phone:785-640-6844
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-04-17
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS13-82155-101163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse