Provider Demographics
NPI:1265111348
Name:BAILEY, SAGE LYLE (DNP)
Entity type:Individual
Prefix:DR
First Name:SAGE
Middle Name:LYLE
Last Name:BAILEY
Suffix:
Gender:M
Credentials:DNP
Other - Prefix:
Other - First Name:SAGE
Other - Middle Name:LYLE
Other - Last Name:TREHEARNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:805 LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:BELLEVUE
Mailing Address - State:NE
Mailing Address - Zip Code:68005-2330
Mailing Address - Country:US
Mailing Address - Phone:303-720-3899
Mailing Address - Fax:
Practice Address - Street 1:3867 LEAVENWORTH ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68105-1113
Practice Address - Country:US
Practice Address - Phone:303-720-3899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-07-14
Last Update Date:2023-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE114874363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care