Provider Demographics
NPI:1457129322
Name:MCDONALD, BAILEY A (PA-C)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:A
Last Name:MCDONALD
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2115 NE WYATT CT STE 201
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-7680
Mailing Address - Country:US
Mailing Address - Phone:541-585-2400
Mailing Address - Fax:541-585-2407
Practice Address - Street 1:2115 NE WYATT CT STE 201
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-7680
Practice Address - Country:US
Practice Address - Phone:541-585-2400
Practice Address - Fax:541-585-2407
Is Sole Proprietor?:No
Enumeration Date:2023-12-19
Last Update Date:2023-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PENDING363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical