Provider Demographics
NPI:1457607806
Name:BAILEY, DENISE JOELL (PA-C)
Entity Type:Individual
Prefix:
First Name:DENISE
Middle Name:JOELL
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1848
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-1848
Mailing Address - Country:US
Mailing Address - Phone:231-727-5211
Mailing Address - Fax:231-727-4571
Practice Address - Street 1:1150 E SHERMAN BLVD STE 1175
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49444-1885
Practice Address - Country:US
Practice Address - Phone:231-672-6740
Practice Address - Fax:231-672-6787
Is Sole Proprietor?:No
Enumeration Date:2012-08-02
Last Update Date:2021-12-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IL085004364363A00000X
AZ5761363A00000X
MI5601008601363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant