Provider Demographics
NPI:1841270055
Name:BAILEY, MOLLIE GEORGETTE (PA)
Entity type:Individual
Prefix:MS
First Name:MOLLIE
Middle Name:GEORGETTE
Last Name:BAILEY
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7495 W 29TH AVE
Mailing Address - Street 2:
Mailing Address - City:WHEAT RIDGE
Mailing Address - State:CO
Mailing Address - Zip Code:80033-8002
Mailing Address - Country:US
Mailing Address - Phone:303-360-6276
Mailing Address - Fax:303-761-2787
Practice Address - Street 1:3981 S RESERVOIR RD UNIT A
Practice Address - Street 2:
Practice Address - City:AURORA
Practice Address - State:CO
Practice Address - Zip Code:80013-3804
Practice Address - Country:US
Practice Address - Phone:303-761-1977
Practice Address - Fax:303-789-7222
Is Sole Proprietor?:No
Enumeration Date:2006-01-23
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPA.0003978363A00000X
MI5601004025363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO34235256Medicaid
MIQ21362Medicare UPIN