Provider Demographics
NPI:1720691678
Name:LAURA T BAILEY APRN PLLC
Entity Type:Organization
Organization Name:LAURA T BAILEY APRN PLLC
Other - Org Name:RESOLUTE HEALTHCARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:NURSE PRACTITIONER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LAURA
Authorized Official - Middle Name:T
Authorized Official - Last Name:BAILEY
Authorized Official - Suffix:
Authorized Official - Credentials:APRN
Authorized Official - Phone:479-751-0190
Mailing Address - Street 1:2907 E JOYCE BLVD STE 5
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72703-5390
Mailing Address - Country:US
Mailing Address - Phone:479-212-8492
Mailing Address - Fax:479-265-3890
Practice Address - Street 1:2907 E JOYCE BLVD STE 5
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:AR
Practice Address - Zip Code:72703-5390
Practice Address - Country:US
Practice Address - Phone:479-212-8492
Practice Address - Fax:479-265-3890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-28
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR1891115663OtherNPI
AR195361001Medicaid
AR203336758Medicaid
AR1891115663OtherNPI
AR1164044228OtherNPI
AR203336758Medicaid