1053064717 NPI number — MRS. CONSTANCE GAINEY BAILEY FNP

Table of content: MRS. CONSTANCE GAINEY BAILEY FNP (NPI 1053064717)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053064717 NPI number — MRS. CONSTANCE GAINEY BAILEY FNP

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053064717
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/04/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
187 MCBOW DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROWESVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29133-9594
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
803-682-4322
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
439 NORTH ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BAMBERG
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29003-1317
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
803-245-7525
Provider Business Practice Location Address Fax Number:
762-212-4581
Provider Enumeration Date:
02/01/2022

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:  25768 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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