Provider Demographics
NPI:1972570596
Name:BAILEY, MIKAL A (PA-C)
Entity Type:Individual
Prefix:
First Name:MIKAL
Middle Name:A
Last Name:BAILEY
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2603 KENTUCKY AVE.
Mailing Address - Street 2:MP2, STE. 403
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003
Mailing Address - Country:US
Mailing Address - Phone:270-415-4800
Mailing Address - Fax:270-415-4801
Practice Address - Street 1:2603 KENTUCKY AVE.
Practice Address - Street 2:MP2, STE. 403
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003
Practice Address - Country:US
Practice Address - Phone:270-415-4800
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-03-02
Last Update Date:2022-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA773363A00000X, 363AM0700X
MT34998363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY9500403200Medicaid
610976324OtherUNITED HEALTHCARE
00000048178OtherANTHEM
KY0044209Medicare PIN
764046OtherHEALTHLINK
KYQ00952Medicare UPIN