Provider Demographics
NPI:1801428255
Name:BAYLESS, ADAYA ALEXANDRA (CPNP)
Entity type:Individual
Prefix:
First Name:ADAYA
Middle Name:ALEXANDRA
Last Name:BAYLESS
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4435 SHANGRI LA DR
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37914-3465
Mailing Address - Country:US
Mailing Address - Phone:865-244-0927
Mailing Address - Fax:
Practice Address - Street 1:3234 MILLER AVE
Practice Address - Street 2:
Practice Address - City:CROSSVILLE
Practice Address - State:TN
Practice Address - Zip Code:38555-6116
Practice Address - Country:US
Practice Address - Phone:865-244-0927
Practice Address - Fax:931-456-0802
Is Sole Proprietor?:No
Enumeration Date:2020-02-04
Last Update Date:2022-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN222015208000000X, 363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No208000000XAllopathic & Osteopathic PhysiciansPediatrics