Provider Demographics
NPI:1396778247
Name:BAILEY, NANCY M (NP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:M
Last Name:BAILEY
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 N HUMPHREYS BLVD
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2146
Mailing Address - Country:US
Mailing Address - Phone:901-322-9080
Mailing Address - Fax:901-322-9097
Practice Address - Street 1:100 N HUMPHREYS BLVD
Practice Address - Street 2:
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2146
Practice Address - Country:US
Practice Address - Phone:901-322-9080
Practice Address - Fax:901-322-9097
Is Sole Proprietor?:No
Enumeration Date:2006-07-07
Last Update Date:2007-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5813363L00000X
MS81-0149363L00000X
ARA01917363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09829255Medicaid
AR157649758Medicaid
TN3929227Medicaid
TN4106008OtherBCBS TN
AR83174OtherBCBS AR
AR83174OtherBCBS AR
TN3929227Medicare PIN
MS09829255Medicaid