Provider Demographics
NPI:1356612873
Name:BAILEY, DAVID CLARK JR (NP-C)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:CLARK
Last Name:BAILEY
Suffix:JR
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2810 LURLEEN B WALLACE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTHPORT
Mailing Address - State:AL
Mailing Address - Zip Code:35476-3249
Mailing Address - Country:US
Mailing Address - Phone:205-333-7670
Mailing Address - Fax:
Practice Address - Street 1:2810 LURLEEN B WALLACE BLVD
Practice Address - Street 2:
Practice Address - City:NORTHPORT
Practice Address - State:AL
Practice Address - Zip Code:35476-3249
Practice Address - Country:US
Practice Address - Phone:205-333-7670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-01-13
Last Update Date:2017-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-077689363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL141939Medicaid
AL05527779OtherBLUE CROSS BLUE SHIELD
AL120I501528Medicare PIN