MEDICARE: MS. SHARITA BAILEY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number State
1	246RM2200X	Medical Laboratory Technician
2	247200000X	Other Technician
3	246RP1900X	Phlebotomy Technician	TX

General Provider Information

NPI Number	:	1528724861
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. SHARITA BAILEY

Provider Business Mailing Address
First Line	:	1616 JUDSON RD STE 5A
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75601-3653
Country	:	US
Telephone Number	:	430-215-6048
Fax Number	:	903-470-7275

Provider Business Practice Location Address
First Line	:	1616 JUDSON RD STE 5A
Second Line	:
City	:	LONGVIEW
State	:	TX
Zip	:	75601-3653
Country	:	US
Telephone Number	:	430-215-6048
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/11/2021
Last Update Date	:	01/13/2022

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Directions to “ MS. SHARITA BAILEY ” Practice Location

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