1528410305 NPI number — MS. AMBER VERDUN BAILEY PA-C

Table of content: MS. AMBER VERDUN BAILEY PA-C (NPI 1528410305)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1528410305 NPI number — MS. AMBER VERDUN BAILEY PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
AMBER
Provider Middle Name:
VERDUN
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
PA-C
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:
1528410305
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/20/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
131 S ROBERTSON ST STE 1300
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
NEW ORLEANS
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70112-2807
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
504-988-5565
Provider Business Mailing Address Fax Number:
504-988-5793

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4224 HOUMA BLVD STE 550
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
METAIRIE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
504-503-7001
Provider Business Practice Location Address Fax Number:
504-503-7002
Provider Enumeration Date:
07/06/2016

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: 363AS0400X , with the licence number:  302034 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 363AM0700X , with the licence number: 302034 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 09979073 , issued by the state of ( MS ) . This identifiers is of the category "MEDICAID".
  • Identifier: 2426401 , issued by the state of ( LA ) . This identifiers is of the category "MEDICAID".




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