Healthcare Provider Details

I. General information

NPI: 1528055852
Provider Name (Legal Business Name): KATHI RICH BAILEY NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/03/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4208 B EVA RD EVA HEALTH CENTER
EVA AL
35621
US

IV. Provider business mailing address

PO BOX 1108
CULLMAN AL
35056-1108
US

V. Phone/Fax

Practice location:
  • Phone: 256-796-5260
  • Fax: 256-796-4639
Mailing address:
  • Phone: 256-737-2882
  • Fax: 256-737-2050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1085894
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: