Provider Demographics
NPI:1942975685
Name:BAGLEY, RACHEL DIANE (NP)
Entity Type:Individual
Prefix:MRS
First Name:RACHEL
Middle Name:DIANE
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:539 E NELSON ST
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450-2730
Mailing Address - Country:US
Mailing Address - Phone:540-464-4900
Mailing Address - Fax:
Practice Address - Street 1:2976 CHAPEL HILL RD STE 300A
Practice Address - Street 2:
Practice Address - City:DOUGLASVILLE
Practice Address - State:GA
Practice Address - Zip Code:30135-1734
Practice Address - Country:US
Practice Address - Phone:678-631-3740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-13
Last Update Date:2023-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN319082207Q00000X, 363LF0000X
VA0024182436363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner