Provider Demographics
NPI:1902415128
Name:BAILEY, VICTORIA R
Entity Type:Individual
Prefix:
First Name:VICTORIA
Middle Name:R
Last Name:BAILEY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1110 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:BRADY
Mailing Address - State:TX
Mailing Address - Zip Code:76825-4717
Mailing Address - Country:US
Mailing Address - Phone:325-240-9990
Mailing Address - Fax:
Practice Address - Street 1:1110 W 2ND ST
Practice Address - Street 2:
Practice Address - City:BRADY
Practice Address - State:TX
Practice Address - Zip Code:76825-4717
Practice Address - Country:US
Practice Address - Phone:325-240-9990
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2020-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX854387163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse