Provider Demographics
NPI:1831339837
Name:BAILEY, JACQUELYN (RN)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:
Last Name:BAILEY
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 1:6507 OLD BRANCH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-2628
Mailing Address - Country:US
Mailing Address - Phone:240-247-0791
Mailing Address - Fax:
Practice Address - Street 1:6507 OLD BRANCH AVE STE 101
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-2628
Practice Address - Country:US
Practice Address - Phone:240-247-0791
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-03
Last Update Date:2023-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR160803163W00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse