Provider Demographics
NPI:1154987550
Name:PEINKOFER, BAILEY RAINE
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:RAINE
Last Name:PEINKOFER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:RAINE
Other - Last Name:KEMP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:26 PEAKVIEW DR
Mailing Address - Street 2:
Mailing Address - City:HENRIETTA
Mailing Address - State:NY
Mailing Address - Zip Code:14467-9005
Mailing Address - Country:US
Mailing Address - Phone:814-203-6875
Mailing Address - Fax:
Practice Address - Street 1:7325 COMMUNITY DR
Practice Address - Street 2:
Practice Address - City:LIMA
Practice Address - State:NY
Practice Address - Zip Code:14485-9772
Practice Address - Country:US
Practice Address - Phone:585-624-1960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-13
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY029960363A00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant