1821539370 NPI number — MRS. SHRILDA GRADNEY BAILEY FAMILY NURSE PRACTIT

Table of content: MRS. SHRILDA GRADNEY BAILEY FAMILY NURSE PRACTIT (NPI 1821539370)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821539370 NPI number — MRS. SHRILDA GRADNEY BAILEY FAMILY NURSE PRACTIT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BAILEY
Provider First Name:
SHRILDA
Provider Middle Name:
GRADNEY
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
FAMILY NURSE PRACTIT
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:
SHRILDA
Provider Other Middle Name:
ANN
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
FAMILY NURSE PRACTIT
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1821539370
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/04/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1308 GREEN OAK DR
Provider Second Line Business Mailing Address:
N/A
Provider Business Mailing Address City Name:
BATON ROUGE
Provider Business Mailing Address State Name:
LA
Provider Business Mailing Address Postal Code:
70815-2026
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
817-291-9019
Provider Business Mailing Address Fax Number:
225-412-4952

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1308 GREEN OAK DR
Provider Second Line Business Practice Location Address:
N/A
Provider Business Practice Location Address City Name:
BATON ROUGE
Provider Business Practice Location Address State Name:
LA
Provider Business Practice Location Address Postal Code:
70815-2026
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
817-291-9019
Provider Business Practice Location Address Fax Number:
225-412-4952
Provider Enumeration Date:
03/16/2017

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: 163W00000X , with the licence number:  RN087065 , registered in the state of LA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: AP138674 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: RN087065 . This is a "REGISTERED NURSE LICENSE" identifier , issued by the state of ( LA ) . This identifiers is of the category "OTHER".




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