Provider Demographics
NPI:1134546781
Name:BAILEY, MICHELLE CHRISTINE (RN, CS, FNP)
Entity type:Individual
Prefix:MS
First Name:MICHELLE
Middle Name:CHRISTINE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:RN, CS, FNP
Other - Prefix:MS
Other - First Name:MICHELLE
Other - Middle Name:CHRISTINE
Other - Last Name:MORAN BAILEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN, CS, FNP
Mailing Address - Street 1:64 LAMPLIGHT DR
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-7245
Mailing Address - Country:US
Mailing Address - Phone:406-585-1018
Mailing Address - Fax:406-522-1656
Practice Address - Street 1:915 HIGHLAND BLVD
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6902
Practice Address - Country:US
Practice Address - Phone:406-414-5546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2020-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT21703363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT1134546781Medicaid