Provider Demographics
NPI:1669929386
Name:BAILEY, DERRICK
Entity type:Individual
Prefix:
First Name:DERRICK
Middle Name:
Last Name:BAILEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:36 MEDICAL GROUP
Mailing Address - Street 2:UNIT 14010 ANDERSEN AFB
Mailing Address - City:APO
Mailing Address - State:AP
Mailing Address - Zip Code:96543-4010
Mailing Address - Country:US
Mailing Address - Phone:671-366-3231
Mailing Address - Fax:
Practice Address - Street 1:36 MEDICAL GROUP
Practice Address - Street 2:
Practice Address - City:ANDERSEN AFB
Practice Address - State:GU
Practice Address - Zip Code:96543-4010
Practice Address - Country:US
Practice Address - Phone:671-366-3231
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-11
Last Update Date:2023-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLRN 9369759163W00000X
FLAPRN11003419363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse