Provider Demographics
NPI:1336361658
Name:BAYLISS, EVERETT HENRY JR (RN CNP)
Entity Type:Individual
Prefix:MR
First Name:EVERETT
Middle Name:HENRY
Last Name:BAYLISS
Suffix:JR
Gender:M
Credentials:RN CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3002
Mailing Address - Street 2:
Mailing Address - City:GETTYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17325-0002
Mailing Address - Country:US
Mailing Address - Phone:614-507-9604
Mailing Address - Fax:
Practice Address - Street 1:121-123 W. MAINE STREET
Practice Address - Street 2:
Practice Address - City:EMMITSBURG
Practice Address - State:MD
Practice Address - Zip Code:21727
Practice Address - Country:US
Practice Address - Phone:301-447-3310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-03
Last Update Date:2019-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR122359163W00000X, 363LF0000X
PARN700615163W00000X
PASP018374363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2679838Medicaid
OH2679838Medicaid