1780135848 NPI number — MRS. CARLY JOY BAILEY FNP-C

Table of content: MRS. CARLY JOY BAILEY FNP-C (NPI 1780135848)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1780135848 NPI number — MRS. CARLY JOY BAILEY FNP-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
CARLY
Provider Middle Name:
JOY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FNP-C
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
GENOVA
Provider Other First Name:
CARLY
Provider Other Middle Name:
JOY
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
FNP-C
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1780135848
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
9706 STATE ROUTE 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GARRETTSVILLE
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44231-9680
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-487-9982
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
30680 BAINBRIDGE RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CLEVELAND
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44139-2282
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-542-5000
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/24/2016

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LF0000X , with the licence number:  APRN.CNP.019795 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)