Provider Demographics
NPI:1336813252
Name:DAUGHERTY, BAILEY MARIE
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:MARIE
Last Name:DAUGHERTY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76642 N 2580 RD
Mailing Address - Street 2:
Mailing Address - City:WATONGA
Mailing Address - State:OK
Mailing Address - Zip Code:73772
Mailing Address - Country:US
Mailing Address - Phone:580-791-3280
Mailing Address - Fax:
Practice Address - Street 1:595 N BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:HYDRO
Practice Address - State:OK
Practice Address - Zip Code:73048-8425
Practice Address - Country:US
Practice Address - Phone:833-274-4174
Practice Address - Fax:866-274-4175
Is Sole Proprietor?:No
Enumeration Date:2021-08-04
Last Update Date:2023-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0117295163W00000X
OK204967363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse