Healthcare Provider Details

I. General information

NPI: 1760052799
Provider Name (Legal Business Name): MISTY BAILEY EDWARDS BSN, RN, CWOCN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/30/2021
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 PRINCETON AVE SW
BIRMINGHAM AL
35211-1303
US

IV. Provider business mailing address

1085 LONG BRANCH PKWY
CALERA AL
35040-5321
US

V. Phone/Fax

Practice location:
  • Phone: 205-783-3075
  • Fax:
Mailing address:
  • Phone: 205-283-2170
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License Number1-125091
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License Number1-125091
License Number StateAL
# 3
Primary TaxonomyY
Taxonomy Code163WX1500X
TaxonomyOstomy Care Registered Nurse
License Number1-125091
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: