Provider Demographics
NPI:1952786097
Name:BAILES, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BAILES
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14973 W BELL RD STE 100
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85374-3878
Mailing Address - Country:US
Mailing Address - Phone:623-934-1245
Mailing Address - Fax:623-934-3598
Practice Address - Street 1:14973 W BELL RD STE 100
Practice Address - Street 2:
Practice Address - City:SURPRISE
Practice Address - State:AZ
Practice Address - Zip Code:85374-3878
Practice Address - Country:US
Practice Address - Phone:623-934-1245
Practice Address - Fax:623-934-3598
Is Sole Proprietor?:Yes
Enumeration Date:2015-07-29
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZAP8666363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ172678Medicaid