Provider Demographics
NPI:1356374110
Name:BAYNE, MARY J (1002817 NCCPA)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:J
Last Name:BAYNE
Suffix:
Gender:F
Credentials:1002817 NCCPA
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Other - Last Name:
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Mailing Address - Street 1:3931 LEIGHWOOD DR
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41102-6711
Mailing Address - Country:US
Mailing Address - Phone:606-324-4677
Mailing Address - Fax:
Practice Address - Street 1:VAMC 1540 SPRING VALLEY DR
Practice Address - Street 2:
Practice Address - City:HUNTINGTON
Practice Address - State:WV
Practice Address - Zip Code:25704
Practice Address - Country:US
Practice Address - Phone:800-827-8244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
DC1002817363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical