Provider Demographics
NPI:1215278361
Name:BRANDT, BAILEY ANNE (PA-C)
Entity type:Individual
Prefix:
First Name:BAILEY
Middle Name:ANNE
Last Name:BRANDT
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BAILEY
Other - Middle Name:ANNE
Other - Last Name:HASTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:2747 NE CONNERS AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-8738
Mailing Address - Country:US
Mailing Address - Phone:541-382-5712
Mailing Address - Fax:503-382-2605
Practice Address - Street 1:2747 NE CONNERS AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-8738
Practice Address - Country:US
Practice Address - Phone:541-382-5712
Practice Address - Fax:541-382-2605
Is Sole Proprietor?:No
Enumeration Date:2013-03-13
Last Update Date:2022-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA173207363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500690561Medicaid
ORR240508OtherMEDICARE PTAN