1477028256 NPI number — KRISTA NIICOLE BAILEY AGPCNP-BC

Table of content: KRISTA NIICOLE BAILEY AGPCNP-BC (NPI 1477028256)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477028256 NPI number — KRISTA NIICOLE BAILEY AGPCNP-BC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
KRISTA
Provider Middle Name:
NIICOLE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
AGPCNP-BC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BENSON
Provider Other First Name:
KRITA
Provider Other Middle Name:
NICOLE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1477028256
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/28/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2717 E OAKLAND AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JOHNSON CITY
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
37601-1843
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
423-926-2358
Provider Business Mailing Address Fax Number:
423-926-2680

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1927 MEMORIAL BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MURFREESBORO
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
37129
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
615-904-9111
Provider Business Practice Location Address Fax Number:
931-728-1016
Provider Enumeration Date:
10/09/2018

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: 363LG0600X , with the licence number:  24900 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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