1669041133 NPI number — KATRINA LYNN BAILEY RDN, PA-C

Table of content: KATRINA LYNN BAILEY RDN, PA-C (NPI 1669041133)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669041133 NPI number — KATRINA LYNN BAILEY RDN, PA-C

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
KATRINA
Provider Middle Name:
LYNN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
RDN, 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:
BAILEY
Provider Other First Name:
KATIE
Provider Other Middle Name:
LYNN
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
RDN, PA-C
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1669041133
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/14/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 10001
Provider Second Line Business Mailing Address:
PMB 1451
Provider Business Mailing Address City Name:
SAIPAN
Provider Business Mailing Address State Name:
MP
Provider Business Mailing Address Postal Code:
96950
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
670-285-7486
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
PO BOX 10001
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SAIPAN
Provider Business Practice Location Address State Name:
MP
Provider Business Practice Location Address Postal Code:
96950-8901
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
670-285-7486
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/21/2021

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: 133V00000X , with the licence number:  86096825 , registered in the state of CO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363A00000X , with the licence number: 1185355 , registered in the state of WI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 86096825 . This is a "REGISTERED DIETITIAN" identifier , issued by the state of ( CO ) . This identifiers is of the category "OTHER".




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