Provider Demographics
NPI:1184238255
Name:BAILEY, ROBERT BRADLEY
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:BRADLEY
Last Name:BAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1458 LEFT FORK MARROWBONE CRK
Mailing Address - Street 2:
Mailing Address - City:KERMIT
Mailing Address - State:WV
Mailing Address - Zip Code:25674-7277
Mailing Address - Country:US
Mailing Address - Phone:304-928-4200
Mailing Address - Fax:
Practice Address - Street 1:1458 LEFT FORK MARROWBONE CRK
Practice Address - Street 2:
Practice Address - City:KERMIT
Practice Address - State:WV
Practice Address - Zip Code:25674-7277
Practice Address - Country:US
Practice Address - Phone:304-928-4200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-04
Last Update Date:2020-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant