Provider Demographics
NPI:1457049207
Name:DEVENPORT, BAILEY (CPNP-PC)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:
Last Name:DEVENPORT
Suffix:
Gender:F
Credentials:CPNP-PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4735 E UNION HILLS DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85050-3362
Mailing Address - Country:US
Mailing Address - Phone:602-971-5121
Mailing Address - Fax:
Practice Address - Street 1:4735 E UNION HILLS DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85050-3362
Practice Address - Country:US
Practice Address - Phone:602-971-5121
Practice Address - Fax:602-242-6945
Is Sole Proprietor?:No
Enumeration Date:2023-04-28
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ289342363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner