Provider Demographics
NPI:1720676802
Name:WALTERS, BAILEY (RN)
Entity Type:Individual
Prefix:MS
First Name:BAILEY
Middle Name:
Last Name:WALTERS
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 CENTRE AVE UNIT 434
Mailing Address - Street 2:
Mailing Address - City:NEW ROCHELLE
Mailing Address - State:NY
Mailing Address - Zip Code:10801-7285
Mailing Address - Country:US
Mailing Address - Phone:716-316-6792
Mailing Address - Fax:
Practice Address - Street 1:800 CROSS RIVER RD
Practice Address - Street 2:
Practice Address - City:KATONAH
Practice Address - State:NY
Practice Address - Zip Code:10536-3549
Practice Address - Country:US
Practice Address - Phone:716-316-6792
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-05
Last Update Date:2022-07-21
Deactivation Date:2022-03-08
Deactivation Code:
Reactivation Date:2022-07-13
Provider Licenses
StateLicense IDTaxonomies
NY803461163W00000X
NYF404167-01363LP0808X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse